Endothelial modulation of pH-dependent pressor response in isolated perfused rabbit lungs

With the use of isolated perfused rabbit lungs (n = 152), roles of endothelium-derived relaxing factor (EDRF) in pulmonary vascular responses to hypocapnia and hypercapnia were studied. Lungs were ventilated with a gas mixture containing 1, 5, or 10% CO2 and 21% O2, adjusting the perfusate pH to 7.8, 7.4, or 7.1, respectively. Methemoglobin (MetHb), hemoglobin (Hb), methylene blue (MB), and L-argininosuccinic acid (L-ASA) were used as modulators of EDRF. To eliminate augmented shear stress, we used papaverine during hypercapnia. As a measure of EDRF, we spectrophotometrically examined nitric oxide (NO) metabolites in the perfusate. Hypocapnia and hypercapnia evoked, respectively, unsustainable vasodilatation and vasoconstriction. Hb, MB, and L-ASA, but not MetHb, produced an increase in baseline pulmonary arterial pressure (Ppa). These agents also exacerbated vasoconstriction during hypercapnia. Hypercapnia and hypocapnia caused an increase and decrease, respectively, in EDRF production. L-ASA suppressed EDRF production in hypercapnic lungs. Papaverine did not suppress EDRF production under hypercapnia. In conclusion, 1) the effects of pH on pulmonary circulation are transient, 2) the increase in Ppa caused by hypercapnia is modulated by EDRF, and 3) the pulmonary EDRF genesis is activated by hypercapnic acidosis but suppressed by hypocapnic alkalosis.

[The effect of ACE inhibitors, beta blockers and calcium antagonists on the responses to pressor stress tests in the elderly hypertensive patients]

The purpose of the study was to elucidate the effects of antihypertensive drugs on the hemodynamics in elderly hypertensive patients. Forty-two elderly hypertensives (mean 72 +/- 5 years) were given either ACE inhibitors (A group: perindopril in 10 and captopril in 4 cases), beta blockers (B group: arotinolol in 15 cases) or calcium antagonists (C group: nifedipine in 3 and nitrendipine in 10 cases) for 8-12 weeks. The responses to handgrip and mental arithmetic stress and cardiac functional changes were determined by echocardiography before and after the medications. The decrease in blood pressure at rest and on the stress tests was similar among the three groups, though the hemodynamic responses to the stress tests showed some differences. In the A group, no hemodynamic changes were seen either at rest or on the stress tests after the medication. In the B group, the heart rate and the cardiac output were decreased at rest, and the increase of them on the stress tests were diminished after the medication. On the contrary, the heart rate and the cardiac output were increased, and showed exaggerated responses on the stress tests in the C group. In conclusion, in antihypertensive treatment of elderly hypertensive patients it is important to consider the effects of the antihypertensive drugs on the hemodynamics, although the comparable decrease in blood pressure is expected.

Common deleted region on the long arm of chromosome 5 in esophageal carcinoma

BACKGROUND & AIMS

The existence of an unknown tumor-suppressor gene on 5q for esophageal carcinoma other than the APC gene has been suggested. The location of the putative tumor-suppressor gene on 5q, distinct from the APC gene, was examined.

METHODS

Sixty-one primary esophageal carcinomas were examined for nine microsatellite loci by the polymerase chain reaction followed by polyacrylamide gel electorophoresis. Loss of heterozygosity at the APC gene locus also was examined by the polymerase chain reaction-restriction fragment length polymorphisms.

RESULTS

Thirty-five of 61 esophageal carcinomas (57%) showed loss of heterozygosity at single or multiple loci on 5q, and the smallest common deleted region was identified at 5q31.1, the location of the IRF-1 gene locus. All tumors showing loss of heterozygosity at the APC gene locus showed complete or large interstitial deletions on 5q.

CONCLUSIONS

Deletion at the APC gene locus may just be the result of large deletions on 5q and may not be important in esophageal carcinogenesis, and the IRF-1 gene or other gene(s) on 5q31.1 may be the true target of frequent deletions on 5q that may play an important role in the pathogenesis of the majority of esophageal carcinomas.

[Cloning of the holocarboxylase synthetase cDNA and identification of mutations prevalent in Japanese HCS-deficient patients]

Holocarboxylase synthetase (HCS) plays an essential role in biotin utilization in cells and its deficiency causes biotin-responsive multiple carboxylase deficiency in humans. We have cloned the human HCS cDNA, which maps to chromosome 21q22.1. Two mutations in the HCS genes of Japanese patients with HCS deficiency have been identified: a transition from T to C which causes an amino acid substitution of proline for leucine at position 237 (L237P) and A single guanine base deletion (delta G1067) followed by premature termination. Transient expression in cultured fibroblasts from a patient after site-directed mutagenesis showed that the L237P mutation was responsible for decreased HCS activity. Hybridization analysis using allele-specific oligonucleotide probes demonstrated that the prevalence of the mutations--L237P and delta G1067--was 50% and 30%, respectively, among Japanese patients with HCS deficiency.

The genes encoding the 5HT1D alpha and 5HT1D beta receptors are unchanged in patients with panic disorder

To determine the serotonergic function in panic disorder, sequencing of the genes encoding the 5HT1D alpha and 5HT1D beta receptors was carried out. The genes for the 5HT1D alpha and 5HT1D beta receptors were amplified by polymerase chain reaction and sequenced by the dideoxy method. Some patients have both nucleotides C and T at position 1080 in 5HT1D alpha receptor gene; however, both of them code the same amino acid, asparagine. The 5HT1D beta receptor gene had a substitution from GCA276 to GCG276, not only panic disorder but also in controls; however, this substitution does not change the corresponding amino acid, alanine92.

The possible roles of hyperlipidemia and mononuclear cells in glomeruli in puromycin aminonucleoside nephrosis in rats

The possibility that hyperlipidemia and an increase of mononuclear cells in the glomeruli could participate in the pathogenesis of minimal change glomerulopathy was evaluated in puromycin aminonucleoside (PAN) nephrosis in rats. Significant increases in intraglomerular CD4-, IL-2-receptor (R)- and ED-1-positive cells were found in PAN rats. Urinary protein excretion and mononuclear cells in the glomeruli of 1% cholesterol diet-fed rats significantly increased, compared with standard diet feeding. Moreover, administration of a subnephrogenic dose of PAN in cholesterol diet-fed rats substantially increased urinary protein excretion and mononuclear cells in the glomeruli. Additionally, antihyperlipidemia agents and immunosuppressive agents prevented urinary protein excretion and increases of CD4-, IL-2R- and ED-1-positive cells in the glomeruli of PAN nephrotic rats. Monoclonal antibodies directed against these cells also prevented urinary protein excretion. These results suggest that CD4-, IL-2R- and ED-1-positive cells and hyperlipidemia are involved in the progression, but not the pathogenesis, of PAN.

Mucopolysaccharidosis IVA: submicroscopic deletion of 16q24.3 and a novel R386C mutation of N-acetylgalactosamine-6-sulfate sulfatase gene in a classical Morquio disease

The N-acetylgalactosamine-6-sulfate sulfatase (GALNS) gene, which is responsible for autosomal recessive mucopolysaccharidosis IVA (MPSIVA), has been assigned to the long arm of chromosome 16, subregion 24.3, an area where the adenine phosophoribosyltransferase (APRT) gene and renal dipeptidase (DPEP I) gene are also localized. Molecular genetic studies on a severely affected patient with MPSIVA (Morquio disease), without karyotypic abnormality, revealed a partial submicroscopic deletion of 16q24.3 and a single point mutation on the other allele, with no functional GALNS activity. The patient, his mother, and siblings were hemizygous for GALNS and APRT loci, evidenced by informative RFLP and gene dosage analyses combined with a fluorescence in situ hybridization, utilizing a partial genomic clone of GALNS, but heterozygosity was retained at the DPEP I locus and proximal D16S7. Haplotyping of the family members revealed recombinational events between DPEP I locus and three other polymorphic loci on the paternal chromosome, localizing GALNS gene on the proximal side to DPEP I gene. As estimated from the genetic distance between two flanking markers of proximal D16S7 and distal DPEP I locus, size of the deletion was less than 3Mb. Mother of the boy and two older siblings were asymptomatic, despite this interstitial deletion of the Giemsa-light G band. The remaining paternal allele had no gene rearrangement but GALNS activity was not encoded as Arginine at 386 was replaced with Cysteine (R386C), suggesting this alteration accounts for the severe phenotype. Allelic loss of APRT is frequently observed in cancer tissues, thereby suggesting that the tumor suppressor gene locates near the APRT locus. No family member has evidence of any malignant disease. This study is apparently the first documentation of interstitial deletion of 16q24.3, involving GALNS and APRT genes.

Extracellular matrix 22-kDa protein interacts with decorin core protein and is expressed in cutaneous fibrosis

A protein with an Mr of 22,000 was purified from bovine dermis. The amino acid sequence of the protein was identical to 22-kDa protein [Neame, P.J. et al. (1989) J. Biol. Chem. 264, 5474-5479] and showed highly homologous sequences to TRAMP (tyrosine rich acidic matrix protein) [Cronshaw, A.D. et al. (1993) Matrix 13, 255-266] and dermatopontin [Superti-Furga, A. et al. (1993) Genomics 17, 463-467]. The protein was proved to associate with decorin and a modified decorin with carboxymethylated cysteinyl residues, but not to assemble to hyaluronate or dermatan sulfate chains. The pyridylethylation of cysteinyl residues in the 22-kDa protein did not affect its binding activity to decorin or modified decorin. Immunohistochemical analyses revealed positive stains in endothelial cells and the periphery of collagen fibers in normal dermis but not in the fibroblasts in tissue. Collagen fibers in sclerotic regions of progressive systemic sclerosis were stained diffusely, suggesting that the 22-kDa protein increases in parallel to the accumulation of collagen in the disease. Western blotting analyses of extracts of cultured endothelial cells revealed a lower Mr protein than that from cultured fibroblasts, suggesting the presence of a molecule related to the 22-kDa protein.

Signal hyperintensities on brain magnetic resonance imaging in elderly depressed patients

In a retrospective brain magnetic resonance imaging study, we evaluated the prevalence and severity of signal hyperintensities in 30 elderly depressed patients and 30 controls matched for age, sex and cerebrovascular risk factors. A semiquantitative scoring method was used to grade findings in T2-weighted and proton density images. The elderly depressed patients had more extended periventricular hyperintensities, especially in the frontal region (depressed vs. control, 87 vs. 57%, p < 0.05), pons (33 vs. 7%, p < 0.05) as well as hyperintensities in the putamen and globus pallidus (57 vs. 27%, p < 0.05). The third ventricle was more dilated in depressed patients than controls after adjustment for age and cerebrovascular risk factors. The global index for ventricular enlargement was correlated significantly (r = 0.36, p < 0.05) with the severity of the hyperintensity in depressed patients. Our results indicate that these hyperintensities, especially in the frontal region, pons and lenticular nuclei, and the dilatation of the third ventricle play an important role, through the frontal-subcortical circuits, in mood regulation of elderly depressed patients.

Mucopolysaccharidosis type I: identification of common mutations that cause Hurler and Scheie syndromes in Japanese populations

alpha-L-Iduronidase (IDUA) deficiency (mucopolysaccharidosis type I; MPS-I) is an inborn error of lysosomal degradation of glycosaminoglycans that results in storage of undegraded glycosaminoglycans in lysosomes. Previous studies in Caucasian populations showed that (1) homozygosity or compound heterozygosity for the W402X and Q70X mutations are the common causes of MPS-I with a severe form (Hurler syndrome), and (2) the presence of R89Q may lead to a milder phenotype. We studied mutations in the IDUA gene from 19 MPS-I patients, including two pairs of siblings, with various clinical phenotypes (Hurler, 6 cases; Hurler/Scheie, 7 cases; Scheie, 6 cases). We report the presence of two common mutations that account for 42% of the 38 alleles in these patients. One is a novel 5-bp insertion between the thymidine at nt 704 and a cytosine at nt 705 (704ins5), which is seen only in the Japanese population. The other is a missense mutation, R89Q, which is also seen in Caucasians, although uncommonly. In the 19 Japanese MPS-I patients, the 704ins5 mutation accounted for 7 of 38 alleles (18%), while the R89Q accounted for 9 of 38 (24%). No Japanese patient was found to carry the W402X or Q70X alleles, the two most common MPS-I mutations in Caucasians. Homozygosity for the 704ins5 mutation is associated with a severe phenotype, and for the R89Q mutation with a mild phenotype. Compound heterozygosity for these two mutations produced an intermediate phenotype. Haplotype analysis using polymorphisms linked to the IDUA locus demonstrated that each mutation occurs on a different specific haplotype, suggesting that individuals with each of these common mutations derive from common founders. These data continue to document the molecular heterogeneity and racial differences in mutations in MPS-I.

Serological analysis of monoclonal anti-E and -e with Japanese E/e variant red cells

The agglutination patterns have been analyzed for the reaction between 24 monoclonal antibodies (MAB) with specificity for the Rh antigen E or e and red cells of E/e variant from Japanese blood donors. The MABs were tested for direct agglutination of papain treated cells at 20 degrees C. The reactions of a full titration series of each MAB with a E/e variant cell were compared to the reactions of that MAB with normal E + e + cells. Sixteen anti-E were divided into a minimum of 6 different agglutination patterns with 8 examples of E variant cells. Eight anti-e gave a minimum of 5 different agglutination patterns with 6 examples of e variant cells.

Correlations between parameters in uroflowmetry and histological compositions in patients with benign prostatic hyperplasia

The objective of this study was to determine whether area densities of histological elements within prostatic adenoma affect objective and subjective parameters of patients with prostatic hyperplasia. Modified uroflowmetry parameters including Qmax/T100, TQmax/T100 and voiding efficiency were also measured. The area densities of histological elements did not affect uroflowmetry parameters. In addition, subjective symptom score was not correlated with morphometric findings. Our findings suggest that the degree of infravesical obstruction as measured by uroflowmetry parameters and symptom scores cannot be explained by the tissue compositions of adenomas alone.

Two year clinical study of a soft acrylic intraocular lens

PURPOSE

To assess the efficacy and safety of a soft acrylic intraocular lens (IOL) in small incision cataract surgery.

METHODS

Sixty-four eyes of 64 patients (mean age 71.0 +/- 7.7 [SD] years) who had phacoemulsification and implantation of a soft acrylic IOL were followed for 2 years.

RESULTS

At day 1, 96.9% of patients had corrected visual acuity of 20/40 or better, and 50.0% had 20/20 or better. At 2 years postoperatively, 100% had 20/40 or better, and 86.3% had 20/20. Surgically induced keratometric cylinder remained quite stable throughout the 2 year follow-up period, with axis-based astigmatism of +/- 0.3 diopters. Flare intensity measured with the laser flare-cell meter was less than that with other type of IOLs measured, including poly(methyl methacrylate) and silicone. Neodymium:YAG laser capsulotomy was performed in seven cases (11.1%). without causing damage to the optic. No other postoperative complications were encountered.

CONCLUSION

Soft acrylic IOLs have clinically apparent advantages in small incision cataract surgery.

Suppression of experimental crescentic-type anti-glomerular basement membrane (GBM) nephritis by FK506 (tacrolimus hydrate) in rats

The effect of FK506 (tacrolims hydrate), an immunosuppressive agent produced by Streptomyces tsukubaensis, on crescentic-type anti-glomerular basement membrane (GBM) nephritis in rats was investigated. When rats were treated with FK506 from 1 or 20 days after the anti-GBM serum injection, FK506 inhibited the increase in urinary protein excretion. Histological observation demonstrated that FK506 suppressed glomerular alterations. In the FK506-treated rats, antibody production and rat-IgG and C3 deposits on the GBM were significantly less than those in the nephritic control group. FK506 treatment suppressed the accumulation of ED-1-positive cells, CD4-positive cells, CD8-positive cells, interleukin-2 (IL-2)-receptor-positive cells, leukocyte-function-associated antigen-1 (LFA-1)-positive cells and intercellular adhesion molecule-1 (ICAM-1)-expression in nephritic glomeruli. However, in the in vitro study, FK506 failed to inhibit the up-regulated ICAM-1 expression on endothelial cells in response to tumor necrosis factor (TNF)-alpha. On the other hand, IL-2 production from the spleen cells isolated from nephritic rats treated with FK506 was lower than that in the nephritic control rats. These results suggest that FK506 is effective against crescentic-type anti-GBM nephritis and that the antinephritic mechanisms of FK506 is due to the inhibition of intraglomerular accumulation and activation of leukocytes through the suppression of ICAM-1 expression and IL-2 production.

[Isolation and purification of pregnancy-associated plasma protein A]

We tried to purify pregnancy-associated plasma protein A (PAPP-A) from normal term maternal serum in this study by means of a three step chromatographic procedure. At first 30 ml of maternal serum samples were applied to a column for sieve chromatography and eluted according to molecular weight. PAPP-A was detected in the high molecular weight fraction area by radioimmunoassay for PAPP-A, and 91% of the total amount of PAPP-A in the maternal samples was recovered. Secondary PAPP-A containing fractions were applied to a Heparin-Sepharose column and eluted by a stepwise increase in NaCl 0.15, 0.30 and 0.60 M in 0.05 M Tris-HCl buffer, pH 7.8. Ninety-three percent of PAPP-A in applied samples was recovered under the 0.6 M NaCl condition. Thirdly the pooled fractions which contained PAPP-A after Heparin-Sepharose affinity chromatography were applied to DEAE-Sephacel Chromatography and eluted by a stepwise increase in NaCl 0.15, 0.30 and 0.45 M in 0.01 M acetate buffer, pH 5.5. Ninety-one percent of PAPP-A in applied samples was recovered under the 0.3 M NaCl condition. Finally PAPP-A containing fractions were concentrated 10 times and 3.8 IU (1.7 mg) of PAPP-A was isolated. The purification schedule removed approximately 99% of total protein in the maternal serum while 74% of PAPP-A was recovered. The purification factor (fold), which was calculated as the increase in specific activity (mIU:PAPP-A/mg:protein) in comparison with the starting value in the maternal serum, was 526. And the purity (mg:PAPP-A/mg:protein) of the final product was 68.4%. Analysis of the final purified material by SDS-PAGE showed a single band of 200kDa, and western blot analysis showed that the main purified protein was PAPP-A. The immunological identity of the PAPP-A purified in this study to the PAPP-A donated by Teisner et al., was recognized by crossed immunoelectrophoresis and tandem crossed immunoelectrophoresis. We hope that the new PAPP-A purified in this study can be utilized for the development of a sensitive and convenient assay for PAPP-A and its standard material, and also for basic study to clarify the biological function of PAPP-A in the human body.

[A case of a univentricular heart developed subaortic stenosis after fontan operation]

The patient was a seven-old-boy with univentricular heart of left ventricular morphology with transposition of the great arteries and coarctation of the Aorta. Pulmonary artery banding and coarctactomy (subclavian flap method) were performed as prior surgery during infancy and significant subaortic stenosis (SAS) was not identified before or immediately after Fontan operation. SAS was suspected in an ejection murmur that developed without symptoms two years and five months after Fontan operation. It became clear that the SAS was caused by both restrictive ventricular septal defect and narrowing of outlet chamber (right ventricle). Surgery was performed with myectomy in the outlet chamber, enlargement of ventricular septal defect and a patch enlargement of the right ventricle outflow tract for relief of the SAS. Postoperative pressure gradient across the subaortic component was decreased, however, valve regurgitation remained grade I to II. The mechanisms of SAS after Fontan operation are related to hypertrophy of the subaortic component that incorporates the infundibulum and trabeculae. Careful morphological investigation is essential in patients with risk factors for SAS Mild deterioration of the ventricular compliance due to progressive SAS may result in reduction of the cardiac function and patient's quality of life. Adequate surgical treatment to relieve the SAS is considered essential before and after Fontan operation.

Disparity between tidal and static volumes of immature lungs treated with reconstituted surfactants

We biologically assessed functions of several reconstituted surfactants with the same minimum surface tension (2-3 mN/m) as "complete" porcine pulmonary surfactant (natural surfactant) but with longer surface adsorption times. Administration of natural surfactant (adsorption time 0.29 s) into the lungs of surfactant-deficient immature rabbits brought a tidal volume of 16.1 +/- 4.4 (SD) ml/kg during mechanical ventilation with 40 breaths/min and 20 cmH2O insufflation pressure. In static pressure-volume recordings, these animals showed a lung volume of 62.4 +/- 9.7 ml/kg at 30 cmH2O airway pressure and maintained 55% of this volume when the pressure decreased to 5 cmH2O. With two reconstituted surfactants consisting of synthetic lipids or isolated lipids from porcine lungs plus surfactant-associated hydrophobic proteins (adsorption times 0.57 and 0.78 s, respectively), tidal volumes were < 38% of that with natural surfactant (P < 0.05), but static pressure-volume recordings were not different. Care is therefore needed in estimating the in vivo function of surfactant preparations from minimum surface tension or static pressure-volume measurements.