Limited TCR repertoire of infiltrating T cells in the kidneys of Sjögren's syndrome patients with interstitial nephritis

To analyze the mechanism of interstitial nephritis in patients with Sjörgren's syndrome (SS), we examined the TCR repertoire of infiltration T cells in kidney, labial salivary glands, and PBLs using a PCR. The repertoire of the TCR V beta gene on infiltrating T cells from the kidneys of SS patients was more restricted than those on infiltrating T cells in labial salivary glands and PBL. The TCR V beta 2 gene was expressed predominantly in six of seven (86%) SS patients. Junctional sequences of cDNAs encoding the V beta 2 gene on infiltrating T cells in the kidneys of five SS patients showed that some of the cells expanded clonally, indicating Ag-driven stimulation rather than superantigen-induced proliferation. The same V beta 2 clones in the kidney were not detected in labial salivary glands of the same SS patients; the conserved amino acid (arginine at position 96) in the CDR3 region of the V beta 2 gene was found at a frequency of 48.0% in the kidney, whereas it was detected in only 15.4% of the clones in lips. In conclusion, these findings suggest the possibility that T cells that infiltrate the kidneys of SS patients with interstitial nephritis might recognize different autoantigens than those that infiltrate labial salivary glands.

[Molecular mechanism on Sjögren's syndrome]

Sjögren's syndrome (SS) is an autoimmune disease characterized by lymphocytic infiltration into lachrymal and salivary glands leading to symptomatic dye eyes and mouth. Immunohistological studies have clarified that the majority of infiltrating lymphocytes around the lachrymal glands and labial salivary glands are CD4 positive alpha beta T cells. To analyze the nature of T cells in lachrymal glands and labial salivary glands, we examined TCR V beta genes of infiltrating T cells into both glands from SS patients, using PCR-SSCP and sequencing methods. The results showed the following two findings. 1) Some of T cells infiltrating in both glands expand clonally, suggesting that these cells proliferate by antigen-driven stimulation. 2) The common T cells accumulated in lachrymal and labial salivary glands. In conclusion, autoreactive T cells in lips and eyes should recognize the same epitopes of autoantigen in individual patients with SS. Further analysis on autoantigen using T cell lines from labial salivary glands supports the notion that Ro/SS-A 52 kD is a possible autoantigen recognized by autoreactive T cells.

Changes of bone mineral density in pregnant and postpartum women

OBJECTIVE

To explore the effects of pregnancy and postpartal lactation on bone mineral density (BMD).

METHODS

In this study, the BMD of 22 pregnant women in a longitudinal study, and of 75 pregnant and 111 puerperant women in a cross-sectional study was estimated at the distal radius of the forearm by dual energy X-ray absorptiometry. BMD was measured on 8 separate occasions from the first trimester of pregnancy to 24 months' postpartum.

RESULTS

In none of 22 pregnant women was there any noticeable change in BMD during pregnancy. Whereas no significant change in BMD occurred during the 12-month postpartum period in 11 non-lactating women, 11 women who breastfed had a significant decrease in BMD at 1, 3, and 6 months' postpartum, with all of them showing a further decrease in BMD at 12 months' postpartum. The BMD of the radius was significantly lower in the breast-feeders than in the formula-feeders at all postpartal times of evaluation except at 24 months' postpartum.

CONCLUSION

It can be recommended that lactating women receive appropriate treatments for saving BMD during lactation.

Immediate early gene expression during morphine withdrawal

The expression of immediate early genes (IEG)s c-fos, c-jun and zif/268 was studied during naloxone-precipitated morphine withdrawal in various organs of the rat. Dependence was induced over a period of 6 days by a graded regimen of 6-hourly injections. Northern analysis revealed peak expression of all IEGs occurred in the forebrain plus cerebellum at 20 min and at 60 min in the brain stem following morphine withdrawal. Increased levels of c-fos and c-jun mRNA were observed in the spinal cord at 40 min of morphine withdrawal. An increase in c-fos and c-jun but not zif/268 mRNAs was seen in the jejunum between 20 and 60 min. Elevated levels of the IEG protein products in the cerebral cortex, hippocampus, thalamus, cerebellum, brain stem and spinal cord were observed at 60 min following morphine withdrawal. These data emphasize the temporal and spatial variation in IEG expression in different tissues during opiate withdrawal.

Fatal cerebral infarction in an asymptomatic young patient with primary antiphospholipid syndrome

An 18-year-old woman with primary antiphospholipid syndrome developed a major cerebral infarction leading to brain death despite intensive treatment with steroids, urokinase, glyceol and heparin. Fatal strokes associated with this syndrome are rare. A computed tomographic scan of the brain suggested occlusion of the main trunk of the right middle cerebral artery. The titer of antibodies against cardiolipin/ beta 2-glycoprotein I complex in serum was extremely high.

In vivo pharmacological study of spermine-induced neurotoxicity

Spermine-induced neurotoxicity and its pharmacological manipulation was studied in the rat striatum in vivo. Spermine (50, 100, 250 nmol) was injected into the striatum and the volume of damage quantified by computer-based image analysis. Spermine produced a dose-dependent increase in the volume of damage. Co-administration of MK-801 ((+)-5-methyl-10,11-dihydro-5H-dibenzo[a,d]cyclohepten-5,10-imine maleate; dizocilpine, 60 nmol), 2,3-dihydroxy-6-nitro-7-sulfamoyl-benzo[f]quinoxaline (25, 40 nmol) and pretreatment with pentobarbital (40 mg/kg, i.p.) significantly reduced the volume of damage induced by 100 nmol spermine. MK-801 (30 nmol) was also effective in reducing the damage induced by 50 nmol spermine. Treatment with a specific inhibitor of nitric oxide synthase, N omega-nitro-L-arginine methyl ester (50 mg/kg, i.p., twice daily for 10 days) was ineffective. These results suggest an involvement of both N-methyl-D-aspartate (NMDA) and non-NMDA glutamate receptors in the cascade of spermine-induced neurotoxicity.

Asterixis and astatic seizures in association with bilateral insular lesions in a patient with viral encephalitis

We report a 48-year-old man who suffered from viral encephalitis and developed involuntary movements of the hands and astatic seizures as sequelae. T2-weighted magnetic resonance imaging of the brain showed high intensity areas in the bilateral insulae. Electroencephalography (EEG) revealed spike and slow wave complexes and high-amplitude slow waves. The involuntary movements of the hands were diagnosed as asterixis by electromyography. Asterixis affected both hands. Administration of sodium valproate aggravated asterixis and EEG findings, but treatment with clonazepam markedly improved these findings and astatic seizures. The present case indicates that insular lesions might be also responsible for the development of asterixis.

Structures of the N-linked oligosaccharides on human plasma vitronectin

The structures of N-linked oligosaccharides present on human plasma vitronectin were elucidated. Oligosaccharides were released from the vitronectin by N-glycosidase F digestion and tagged with 2-aminopyridine; the pyridylamino-oligosaccharides were then fractionated by anion-exchange and reverse-phase HPLC. Ten major pyridylamino-oligosaccharides were isolated. The linkages and locations of sialic acid residues were determined by desialylation with Salmonella sialidase in combination with acid. The asialo forms were then analyzed by two-dimensional sugar mapping, component sugar analysis and 400-MHz 1H-NMR spectroscopy. The major oligosaccharides of human vitronectin were of the diantennary N-acetyllactosamine type, with a lesser amount of the tri- and a small amount of the mono-antennary type, to which 1-3 mol sialic acid residues were linked, mostly through alpha 2-6 linkages, although alpha 2-3 linkages were also present. The possibility that several binding activities of vitronectin can be ascribed to its glycan moiety was discussed, based on the specific features of the N-linked oligosaccharides on human vitronectin revealed here.

Two-stage bronchoplasty for synchronous contralateral lung cancers

A 62-year-old male with two synchronous squamous-cell carcinoma was successfully treated in two stages by right upper sleeve lobectomy and left S6 sleeve segmentectomy. The patient remains well without recurrence two years after surgery. Bronchoplastic surgery is an effective approach for multicentric hilar cancers with poor pulmonary function.

Gas chromatography-mass spectrometric studies of canine urinary metabolism

After the urine was treated with urease, lyophilized, and trimethylsilylated, it was examined for metabolic profiles in Dalmatian dogs and Shetland sheepdogs by gas chromatography-mass spectrometry (GC/MS), which simultaneously analyzes organic acids, amino acids, sugars, sugar alcohols, purine and pyrimidine bases, and nucleosides. The profiles were compared with those from human specimens. As clarified in past studies, Dalmatian dogs showed an extreme decrease in allantoin, which is the final product of purine metabolism in the canine of other species, and a marked detection of uric acid peak. This finding suggests that purine metabolism in Dalmatian dogs is different from that in the other species. Only two Shetland sheepdogs, whose mother had chronic renal failure, showed a marked excretion of uric acid, as in Dalmatian dogs. In addition, some Dalmatian dogs, who were maintained on a protein-restricted diet, showed a little excretion of uric acid. A large amount of uric acid is detected in combination with pentose-monosaccharides, hexose-monosaccharides and sugar alcohols in neonatal human urine in comparison with the present dog samples. A marked difference between the canine and the humans is that phenylacetylglycine, which is derived from the aromatic amino acid phenylalanine, is excreted in the canine urine. Phenylacetylglycine is not detected in the human urine, and there have been no reports of its excretion in canine urine.

Corticosterone secretion in response to serotonin and ACTH by perfused adrenal of normal and athymic nude mice

Adrenocortical secretory responses to chemical mediators and ACTH in CD1 ICR nu/nu (athymic) mice were compared with those in CD1 ICR (normal) mice. The bilateral adrenals of normal or athymic mice were perfused in situ with artificial medium equilibrated by 95% O2 + 5% CO2. Infusion of serotonin induced the secretory response of corticosterone significantly at 10 nM and markedly at 100 nM and the response at 1000 or 10000 nM declined as compared with that at 100nM in normal mice. Total corticosterone secretion in response to 100 or 1000 nM serotonin in athymic mice was about one fourth that in normal mice, respectively. Corticosterone responses to ACTH at the range of 10 to 300 pg/ml in athymic mice were comparable to those in normal mice. Infusion of histamine, platelet activating factor(PAF), or compound 48/80 did not induce significant corticosterone response in both normal and athymic mice. The data suggest that the congenital defect of the thymus and/or hair causes the hyporesponsiveness of adrenocortical cells to serotonin although the adrenal cortex of athymic mice is able to perform its function in response to ACTH.

[Halothane reduces the inhibition of dorsal horn lamina V type neuronal activity induced by bradykinin injection into the femoral artery contralateral to the recording site]

Effect of halothane (0.2%, 0.5%, and 1.0%) on spinal function were studied in lamina V type cells responding to noxious and light touch applied at their cutaneous receptive field on the foot pad of the left hind paw. Extracellular unit activities of lamina V type cells were recorded at the lumbar level in six cats and thirteen spinal cats. When intra-arterial injection of bradykinin (BK) 10 micrograms into the femoral artery ipsilateral to the recording sites was used as the noxious test stimuli, six of these cells (100%) were found to have inhibitory response in six intact cats and thirteen of these cells (100%) were found to have excitatory response in thirteen spinal cats. On the other hand, when the injection of 10 micrograms into the femoral artery contralateral to the recording sites was used as the noxious test stimuli, six of these cells (100%) were found to have inhibitory response in six intact cats and six of these cells (46%) were found to have inhibitory response in thirteen spinal cats. We studied the effect of halothane on the inhibition induced by BK injection into the femoral artery contralateral to the recording sites in six intact cats and six spinal cats. Halothane 0.2%, 0.5% and 1.0% reduced the inhibition of dorsal horn lamina V type neuronal activity induced by BK injection.

A putative digestive cysteine proteinase from Drosophila melanogaster is predominantly expressed in the embryonic and larval midgut

Plant seeds have biodefense systems for protection against insects. One of these systems may be based on the occurrence of phytocystatins, cysteine proteinase inhibitors of plant origin, that probably inhibit insect cysteine proteinases involved in digestive functions. To elucidate a molecular mechanism for this biodefense phenomenon, we isolated a gene encoding a putative digestive cysteine proteinase from Drosophila melanogaster, a suitable model species. The cloned genomic DNA fragment contained a sequence encoding a cysteine proteinase. The mature enzyme from the encoded protein, termed Drosophila cysteine proteinase-1, consisted of 218 amino acid residues. Drosophila cysteine proteinase-1 showed 67% similarity in its amino acid sequence to a lobster cysteine proteinase-3 contained in the digestive juice. This enzyme also showed significant similarities to cysteine proteinases of animal origin such as cathepsins H and L, and to proteinases of plant origin such as rice oryzains alpha and beta. In situ hybridization studies for the embryo showed that the mRNA for Drosophila cysteine proteinase-1 was predominantly expressed in the midgut. Larval alimentary organs, such as the salivary gland and the midgut including the gastric caeca, also expressed the mRNA at significant levels. These observations, suggesting that Drosophila cysteine proteinase-1 is a digestive cysteine proteinase which can be used as a model target of phytocystatins, will hopefully lead to new strategies for the regulation of pest insects.

Results of surgical treatment of pulmonary metastases

From 1970 to 1993, 155 thoracotomies for metastatic lung tumors were performed on 113 patients in the Department of Surgery, Kanazawa University School of Medicine. Overall 30-day mortality amounted to 0.9% (1/113). The cumulative 3- and 5-year survival rates were 39.4% and 29.1%, respectively. The overall median survival was 24 months. The 5-year survival rate for carcinoma was 37.2% and for sarcoma it was 14.5% (P < 0.01). The other significant predictors of better long-term survival with metastatic lung tumors were solitary lesions, disease-free interval (DFI) > 24 months, and tumor size < or = 20 mm in diameter. There was no significant difference in survival based on the method of pulmonary resection. Repeat thoracotomy for recurrent metastases was performed in 27 patients, whose 5-year survival rate after the first lung resection was 35.5%. For bilateral pulmonary metastases, we recently performed simultaneous bilateral thoracotomy via median sternotomy on 25 patients and transsternal simultaneous bilateral thoracotomy on 8 patients. The latter procedure provides a wide operative field and better survival. We conclude that resection of metastatic lung tumors is safe and effective, and that repeat thoracotomy is warranted in selected patients with recurrent pulmonary metastases.

[Reoperation for recurrent and second primary lung cancer]

Thirty patients have undergone multiple resections for non-small cell lung cancer from 1973 to July 1994, constituting 2.6% of 1,153 who had undergone pulmonary resection for such tumor. In the 22 patients for recurrent cancer, 15 resections of the ipsilateral lung and 9 of the contralateral lung were performed with no operative death. The survival rate following second resection in 22 patients was 33.8% at 3 years and 13.5% at 5 years. Survival rate was poor in patients with DNA aneuploid primary tumor and there was not a patients of 5 years survival. Three out of the 5 patients which had a diploid pattern in the primary tumor, showed an aneuploid pattern in the recurrent tumor. Long survival patients were founded only in the patients which had a diploid primary tumor. In the 8 patients for second primary lung cancer, 4 resections of the ipsilateral lung and 4 of the contralateral lung were performed, including two bronchoplastic surgery for early hilar squamous cell carcinoma. The survival rate following second resection in 8 patients was 64.2% at 5 years with good result. We concluded that an aggressive surgical approach is safe and warranted in patients with second primary lung cancer.

Expression of the genes coding for ornithine decarboxylase and its regulatory protein antizyme in the developing rat brain

The ontogenic expression of the genes coding for ornithine decarboxylase (ODC) and its inhibitory protein, antizyme (AZ), was studied in the rat brain between embryonic day (E) 16 and postnatal day (P) 66. The level of ODC mRNA in whole brain was maximal at P2 and rapidly declined by P7 to a low level that was maintained into the adult. Levels of AZ mRNA also peaked at P2, and high levels were sustained into the adult. Regional studies indicated that between P2 and P60 ODC mRNA levels declined in the cerebral cortex, hippocampus and brainstem. These changes reflect the ontogenic pattern of protein levels and enzyme activity suggesting control of this enzyme may occur at the level of transcription. The level of AZ mRNA markedly increased in the cerebellum between P10 and P60. The level of ODC and AZ mRNA at P5 was not altered after continuous suppression of ODC enzyme activity by alpha-difluoromethylornithine between P0 and P5. This suggests that ODC gene expression is not subject to product-related feedback inhibition during this period. Immunohistochemical localisation of ODC protein at P5 revealed ubiquitous distribution of immunoreactivity with higher levels in the hippocampus, cerebral cortex and discrete nuclei in the brainstem. ODC protein was undetectable in the adult rat brain.

The induction of immediate early genes in postischemic and transplanted livers in rats. Its relation to organ survival

The protein products of the immediate early genes (IEG)s have been proposed to play an important role in long-term tissue plasticity such as cell repair or programmed cell death. The expression of liver IEGs was studied following liver ischemia (LI) or OLT in rats. In LI, 60 min of warm ischemia was induced in shunted rats (shunt LI group; 100% survival) and nonshunted rats (nonshunted LI group; poor survival). In OLT, donor livers were transplanted into the recipients within 1 hr (fresh liver OLT group; 100% survival) or after 24 hr of storage using University of Wisconsin solution (preserved liver OLT group; poor survival). Using both models, IEG mRNAs (c-fos and c-jun) were analyzed by Northern blot hybridization at various times before and after reperfusion. The expression of liver IEGs was not induced by warm ischemia and cold preservation alone. Reperfusion of livers following warm ischemia or cold preservation resulted in a distinctly different pattern of gene expression in viable and nonviable livers. In shunted LI and fresh liver OLT groups (viable), c-fos and c-jun mRNAs increased markedly to a peak value within 1-2 hr of reperfusion, returning to basal level by 3 hr. In nonviable livers, the level of these mRNAs was detected continuously at 3 hr of reperfusion in the nonshunted LI model and also at 6 hr after reperfusion in the preserved liver OLT group. Our data suggest that a protracted pattern of expression of c-fos and c-jun in the liver at the early stage of reperfusion might be correlated with the severity of liver transplant-related insults and subsequent graft failure.

Antigenicity of the oligosaccharide moiety of the Japanese cedar (Cryptomeria japonica) pollen allergen, Cry jI

Cry jI, a major allergenic glycoprotein of Cryptomeria japonica (Japanese cedar, Sugi), is the most common pollen allergen in Japan. Carbohydrate analysis and lectin staining indicated that Cry jI possesses the fucose/xylose-containing N-linked oligosaccharide which previously has been found in some plant glycoproteins. Rabbit polyclonal anti-Cry jI IgG antibodies were found to be highly cross-reactive with two other plant glycoproteins which have the same type of oligosaccharides, and the cross-reactivities were completely abolished on chemical deglycosylation of the glycoproteins. Enzyme-linked immunosorbent assay inhibition showed that the majority (up to 70%) of the anti-Cry jI rabbit IgG antibodies recognized the oligosaccharide moiety of Cry jI. The carbohydrate epitopes were found to be only partially involved in the binding of specific IgE antibodies from a pool of human patient sera.

Development of a new intraoperative radiofrequency ablation technique using a needle electrode

We studied a new intraoperative technique for radiofrequency ablation using a needle electrode. The ventricles of 12 mongrel dogs were ablated. The needle electrode was inserted to a depth of 3 mm through the epicardium. Macroscopically, tissue defect was found only at the needle insertion site. The degenerated area had a well-demarcated bullet shape with microscopical coagulation necrosis. This characteristic shape allows the ablation of deeper areas of the myocardium by deeper insertion of the ablation needle. Compared with conventional epicardial surface ablation, this new method could be used to achieve deeper coagulation. For any given energy level and conductance, the ratio between the volume and the depth of the lesion with this new method is smaller than that of lesions made by the conventional radiofrequency ablation method. With this new method, the energy spreads vertically, a characteristic suitable for deep ablation. This may result from the shape of the needle electrode itself. For ablation of deep targets, this new method is superior to the conventional approach because less myocardium is coagulated and the target can be ablated with greater efficiency, requiring the destruction of less tissue. In conclusion, the needle electrode procedure can achieve a narrower ablation for deeper targets than can the conventional technique.

[Effect of isoflurane on spinal dorsal horn WDR neuronal activity in cats]

The effects of isoflurane (0.5% and 1.5%) on the spinal dorsal horn wide dynamic range (WDR) neuronal activity were studied in either spinal cord intact or spinal cord-transected cats. Extracellular activity was recorded in the dorsal horn from single WDR neurons responding to noxious and non-noxious stimuli applied to the cutaneous receptive fields on the left hind foot pads of intact or decerebrate, spinal cord transected (L1-2) cats. When bradykinin (BK) 10 micrograms was injected into the femoral artery ipsilateral to the recording site as the noxious test stimulus in the spinal cat, all of 17 WDR neurons gave excitatory responses which were not depressed by 0.5% isoflurane but were depressed significantly by 1.5%. On the other hand, when the injection of BK 10 micrograms into the femoral artery ipsilateral to the recording site was used in the intact cat, 13 of 24 WDR neurons (54%) gave excitatory responses, which were significantly depressed by 0.5% and 1.5% isoflurane, and 11 of 24 WDR neurons (46%) gave inhibitory responses, which were significantly depressed by 0.5% and 1.5% isoflurane. We have found that isoflurane reduces the excitation as well as the inhibition of dorsal horn WDR neuronal activity induced by BK injection.

Ga-Al-As laser irradiation inhibits neuronal activity associated with inflammation

A Ga-Al-As diode system that produces low-energy red light (830 nm, 40 mW) has been used for the treatment of many kinds of pain. The mechanism of action of this new laser irradiation for analgesia was studied in anesthetized rats. The effect of laser irradiation of the saphenous nerve was studied by recording neuronal activity at the L4 dorsal root filaments after the injection of a chemical irritant, turpentine. Laser irradiation inhibited both the asynchronous firing by that was induced by turpentine and increased part of the slow components of the action potentials. Thus, the laser irradiation selectively inhibited nociceptive signals at peripheral nerves.

Urinary carnitine excretion in patients with heart failure

To evaluate the fatty acid metabolism in heart failure, the semiquantitative analysis of urinary free carnitine and acylcarnitine was made by fast atom bombardment mass spectrometry (FABMS) in 22 patients (mean age 67.3 years) with heart failure and 19 age-matched healthy controls (average age 60.4 years). Urinary excretion of free carnitine was 0.20 +/- 0.118 ratio/mg creatinine in the healthy controls and 1.32 +/- 1.170 ratio/mg creatinine in the patients with heart failure. The latter value was significantly higher (p < 0.01). Patients with heart failure were classified into two groups according to the urinary free carnitine concentration. One was the high excretion group (2.19 +/- 0.102 ratio/mg creatinine, 12 cases) and the other was the low excretion group (0.37 +/- 0.212 ratio/mg creatinine, 10 cases). In the high excretion group, urinary acetylcarnitine was also increased, but no significant abnormalities were observed in the urinary organic acid profile. In the high group, 1 patient was classified as NYHA class III and 11 as NYHA class IV. Four patients died in the hospital. In the low excretion group, five patients were classified as NYHA class III and five as NYHA class IV. Only one patient died in the hospital. In the high group, patients with severe and prolonged heart failure tended to maintain higher values of urinary free carnitine. We could not find any abnormalities in fatty acid metabolism in patients with heart failure, but it is suspected that the patients who excrete large amounts of free carnitine into the urine, namely the patients with severe heart failure, have some possibility of carnitine deficiency.