Contribution of sustained Ca2+ elevation for nitric oxide production in endothelial cells and subsequent modulation of Ca2+ transient in vascular smooth muscle cells in coculture

To elucidate the intracellular Ca2+ (Ca2+i ) transient responsible for nitric oxide (NO) production in endothelial cells (ECs) and the subsequent Ca2+i reduction in vascular smooth muscle cells (VSMCs), we administrated four agonists with different Ca2+i-mobilizing mechanisms for both cells in iso- or coculture. We monitored the Ca2+i of both cells by two-dimensional fura-2 imaging, simultaneously measuring NO production as NO2-. The order of potency of the agonists in terms of the peak Ca2+i in ECs was bradykinin (100 nM) > ATP (10 microM) > ionomycin (50 nM) > thapsigargin (1 microM). In contrast, the order in reference to both the extent of Ca2+i reduction in cocultured VSMCs and the elevation in NO production over the level of basal release in ECs completely matched and was ranked as thapsigargin > ionomycin > ATP > bradykinin. Treatment by NG-monomethyl-L-arginine monoacetate but not indomethacin or glybenclamide restored the Ca2+i response in cocultured VSMCs to the isoculture level. In ECs, when the Ca2+ influx was blocked by Ni2+ or by chelating extracellular Ca2+, all four agonists markedly decreased NO production, the half decay time of the Ca2+i degenerating phase, and the area under the Ca2+i curve. The amount of produced NO hyperbolically correlated to the half decay time and the area under the Ca2+i curve but not to the Ca2+i peak level. Thus, the sustained elevation of Ca2+i in ECs, mainly a result of Ca2+ influx, determines the active NO production and subsequent Ca2+i reduction in adjacent VSMCs. Furthermore, L-arginine but not D-arginine or L-lysine at high dose (5 mM) without agonist enhanced the NO production, weakly reduced the Ca2+i in ECs, and markedly decreased the Ca2+i in VSMCs, demonstrating the autocrine and paracrine effects of NO (Shin, W. S., Sasaki, T., Kato, M., Hara, K., Seko, A., Yang, W. D., Shimamoto, N., Sugimoto, T., and Toyo-oka, T. (1992) J. Biol. Chem. 267, 20377-20382).

[Clinical analysis on the course and prognosis of patients with Crohn's disease]

We analyzed 66 cases (47 males and 19 females) of Crohn's disease at Hiroshima University hospital from September 1975 to October 1994 to clarify the course and prognosis of Crohn's disease. The age at onset was 21.1 +/- 7.3 years old (mean +/- SD), terms between onset and diagnosis were 21.5 +/- 33.0 months (mean +/- SD) and observation period was 65.5 +/- 44.6 months (mean +/- SD). Sites of lesion were 18 ileum, 41 ileocolon and 7 colon. Thirty-one cases, 20 cases of which had intestinal obstruction, underwent surgical operation (12 ileum types, 18 ileocolic types, 1 colon type). The cumulative probability of surgery at one, five and ten years after onset of symptoms were 12.1%, 28.8% and 56.9%, respectively. As for cumulative probability of surgical operation at one, five and ten years after diagnosis were 25.8%, 36.7% and 74.4%, respectively. Results of the cumulative probability of surgery by anatomical involvement indicated that the ileum type had a statistically significantly higher risk than other types. In each analysis compliance to nutritional therapy was also an important prognostic factor. Overall, our results indicated that the site of lesion and the compliance to nutritional therapy were important factors which have an effect on the course and prognosis of Crohn's disease patients.

Interleukin-4 inhibits prostaglandin G/H synthase-2 and cytosolic phospholipase A2 induction in neonatal mouse parietal bone cultures

We have shown previously that prostaglandin (PG) production in 7-day-old neonatal mouse calvarial cultures is regulated largely by changes in prostaglandin G/H synthase-2 (PGHS-2) expression and to a lesser extent by changes in arachidonic acid (AA) release. In this study, we examined the effects of interleukin-4 (IL-4), and its interactions with other cytokines and with parathyroid hormone (PTH), on mRNA levels of PGHS-2, PGHS-1, and cytosolic phospholipase A2 (cPLA2) and on medium protaglandin E2 (PGE2) levels in calvarial cultures. IL-1 and tumor necrosis factor-alpha (TNF-alpha), both at 1-100 ng/ml, and PTH at 0.1-10 nM increased PGHS-2 and cPLA2 mRNA and medium PGE2 levels dose-dependently after 4 h of treatment. IL-6 and IL-11 at 1-100 ng/ml did not affect mRNA or PGE2 levels. IL-4 at 1-100 ng/ml decreased PGHS-2 and cPLA2 mRNA and PGE2 levels in control as well as IL-1, TNF-alpha, and PTH-stimulated cultures. The inhibition of PGHS-2 and cPLA2 mRNA expression by IL-4 (10 ng/ml) was present at 1 h, reached a maximum at 4 h, and persisted for 24 h. The effects were maintained in the presence of cycloheximide. IL-4 also decreased PGHS-2 protein levels in control and IL-1-stimulated cultures. PGHS-1 mRNA levels were not stimulated by any of the factors studied nor inhibited by IL-4. IL-4 partially inhibited control and PTH-stimulated 45Ca release from prelabeled mouse calvariae at 4 days. However, neither the inhibition of resorption by IL-4 nor the stimulation by IL-1 and PTH were altered by indomethacin (1 microM). We conclude that (1) IL-1, TNF-alpha, and PTH, but not IL-6 nor IL-11, can increase the expression of PGHS-2, cPLA2, and PGE2 production in cultured mouse calvariae; (2) IL-4 inhibits PGE2 production in both control and stimulated calvarial cultures by inhibiting PGHS-2 and cPLA2; and (3) IL-4 has an inhibitory effect on bone resorption which is independent of PG production.

[Serum levels of solubule tumor necrosis factor (TNF) receptors in patients with pulmonary tuberculosis]

Tumor necrosis factor alpha (TNF-alpha) is released from cells of monocyte/macrophage lincage and mediates the development of a variety of clinical and pathomorphological features in various infectious diseases, autoimmune diseases and cancer. In the case of tuberculosis, it is suggested that the release of TNF-alpha in the affected regions and into the circulation could account for the pathological and clinical features such as the development of necrotic lesions and fever and weight loss in TB patients. In the present study, the levels of soluble TNF receptor type I (sTNFR type I) and type II (sTNFR type II) and TNF-alpha in the sera of patients with pulmonary TB were assayed, and we tried to know whether these levels have clinical significance in determining the disease activity in TB patients. The serum levels of both sTNFR types I and II were significantly higher in TB patients (n = 22) who were previously untreated than in the healthy control (n = 14): for sTNFR type I, 2.82 +/- 1.37 ng/ml vs. 1.40 +/- 0.33 ng/ml (p < 0.0001), and for sTNFR type II, 3.83 +/- 1.76 ng/ml vs. 1.62 +/- ng/ml (p < 0.0001). The serum levels of sTNFR types I and II in TB patients showed significant correlations with their serum levels of CRP. The serum levels of TNF-alpha in these TB patients was 2.21 +/- 1.72 pg/ml, whereas TNF-alpha was not detectable in the sera of 9 healthy control. The serum levels of sTNFR type I and II were significantly higher in cavitary TB (n = 17) than in non-cavitary TB (n = 5). When TB patients were treated with antituberculosis drugs and clinical improvements were achieved, the elevated levels of sTNFR type I and TNF-alpha in the sera of same 5 patients measured before starting treatment showed significant decline and the serum levels of sTNFR type II showed also declined, however, the decline was statistically not significant. From all the results obtained in this study, we conclude that the assay of the serum levels of sTNFR in TB patients is useful in the evaluation of the disease activity of TB.

Multichannel optical recording of neuronal network activity and synaptic potentiation in dissociated cultures from rat hippocampus

The activity of neuronal networks formed by dissociated rat hippocampal neurons was observed with a 128-channel optical recording apparatus using an absorptive voltage-sensitive dye, RH482. Two-dimensional patterns of neural electrical events along somata and neurites in the networks were visualized as the responses to pulse stimuli applied to the somata of the presynaptic neurons by patch-clamp electrodes. Synaptic delay was analyzed from propagation delay of the responses along the neurites. Synaptic potentiation was also observed in postsynaptic responses that were amplified by a factor of 1.24 after tetanization. In contrast, presynaptic components were unaffected by the procedure. In the light of the present results, multichannel optical recording promises to promote our understanding of neuronal interactions at cellular level.

Enhanced expression of beta-adrenergic receptor kinase 1 in the hearts of cardiomyopathic Syrian hamsters, BIO53.58

We cloned an entire encoding sequence of beta-adrenergic receptor kinase 1 (beta ARK1) cDNA from the hearts of Syrian hamsters through reverse transcription and subsequent polymerase chain reaction. The cloned cDNA contained 2067 nucleotides coding 689 amino acids. The sequence had 95% homology to rat beta ARK1 and 90% homology to human homologue. Cardiomyopathic Syrian hamster, BIO53.58, has been used as a model animal of congestive heart failure. M-mode echocardiography confirmed that left ventricular contractility of 20-week-old BIO53.58 was markedly reduced. The expression of beta ARK1 mRNA in the hearts of BIO53.58 was significantly increased compared to control hamsters, F1b, suggesting that the enhanced beta ARK1 expression is acting as a negative feedback mechanism in order to maintain intracellular homeostasis against accelerated stimulation by catecholamines via phosphorylation of beta-adrenergic receptor.

Intact insulin-like growth factor binding protein-5 (IGFBP-5) associates with bone matrix and the soluble fragments of IGFBP-5 accumulated in culture medium of neonatal mouse calvariae by parathyroid hormone and prostaglandin E2-treatment

We examined the distribution of insulin-like growth factor binding proteins (IGFBPs) in cultured neonatal mouse calvariae. IGFBP-3 and -4 were predominantly found in the conditioned medium. IGFBP-2 was partitioned between conditioned medium and bone and extracellular matrix (BECM), while intact (31-kDa) IGFBP-5 was most abundant in BECM extracts. After treatment with parathyroid hormone (PTH, 10(-8) M) or prostaglandin E2 (PGE2, 10(-6) M), immunoreactive IGFBP-5 accumulated in the conditioned medium in a 21-kDa form which did not bind IGF-I on Western ligand blots. PTH and PGE2 did not alter the level of steady-state IGFBP-5 mRNA, nor markedly stimulate IGFBP-5 synthesis in the calvariae, and thus accumulation of 21-kDa IGFBP-5 was largely due to release from BECM. This accumulation of truncated IGFBP-5 in the conditioned medium was not dependent on osteoclastic bone resorption, since it was not blocked by calcitonin or a bisphosphonate which inhibited PTH- and PGE2-stimulated 45Ca-release. The conditioned medium from PTH- or PGE2-treated cultures degraded recombinant human IGFBP-5 into lower molecular weight fragments. Addition of IGF-1 at 10(-8) M into the culture resulted in accumulation of native 31-kDa IGFBP-5. However, even in the presence of IGF-1, the native IGFBP-5 was degraded and the 21-kDa product accumulated in the culture medium. These results suggested a possible proteolytic mechanism for 21-kDa IGFBP-5 accumulation, responsive to PTH and PGE2. Aprotinin, leupeptin, cystatin, and bestatin did not inhibit the effects of PTH and PGE2 in the cultures. The localization of IGFBP-5 in BECM and its release and proteolysis induced by PTH and PGE2 could play a role in the local regulation of bone metabolism.

[Significance of hot shot in patients with unstable angina undergoing emergency coronary artery bypass graft surgery]

We investigated the efficacy of terminal warm blood cardioplegia (hot shot) in patients with cardioplegic techniques. From January 1991 through April 1993, 68 patients recieved hypothermic cardioplegia induced by cold modified St. Thomas' Hospital solution containing 10mg/L of diltiazem hydrochloride followed by intermittent infusion of the cold crystalloid solution or cold blood cardioplegia without hot shot. From May 1993 through December 1994, 65 patients recieved hot shot before removal of aortic cross-clamp following the hypothermic cardioplegia. The earlier group consisted of 51 patients with stable angina undergoing elective CABG and 17 patients with unstable angina undergoing emergency of urgent CABG. The later group consisted of 44 patients with stable angina and 21 patients with unstable angina. The unstable angina undergoing coronary artery bypass graft surgery (CABG) using antegrade incidence of perioperative myocardial infarction was significantly higher in patients with unstable angina without hot shot (35%) compared to those with stable angina with and without hot shot (2% and 4%, respectively) and those with unstable angina with hot shot (5%). The level of maximum creatine kinase-MB (IU/L) was significantly greater in patients with unstable angina without hot shot (134 +/- 26) compared to those with stable angina with and without hot shot (57 +/- 7 and 65 +/- 4, respectively) and those with unstable angina with hot shot (57 +/- 8). The doses of dopamine and dobutamine (mg/kg) administered during 48 hours after CABG was not different between patients with stable angina with and without hot shot (13.9 +/- 0.9 vs 13.9 +/- 0.9), but tended to be lower in patients with unstable angina with hot shot (13.7 +/- 1.3) compared to those without hot shot (18.6 +/- 2.1). Left ventricular stroke work index (g.m/m2/b) immediately after CABG was comparable between patients with stable angina with and without hot shot (40 +/- 2.0 vs 36 +/- 1.5), but significantly greater in patients with unstable angina with hot shot (39 +/- 2.3) compared to those without hot shot (29 +/- 2.2). These results suggest that hot shot may provide a significant benefit in myocardial preservation during CABG especially in patients with unstable angina.

Selective Isolation of DNA or RNA Using Single-Stranded DNA Affinity Latex Particles

We developed latex particles with a diameter of about 0.22 µm on which single-stranded (ss) DNA was covalently coupled to select or enrich its complementary DNA or mRNA. DNA was first covalently coupled to the latex particles in the double-stranded (ds) form with both blunt and protruding ends. More than 80% of the dsDNA was coupled through the ssDNA stretch at its protruding end. The presence of NaCl in the immobilization reaction severely inhibited DNA from coupling to the particles. The particles were then treated with alkali or heated to denature the dsDNA and sedimented by a brief centrifugation to yield ssDNA immobilized particles. They allowed the selective and efficient isolation of a desired RNA from total cellular RNA.

Leukocyte function-associated antigen-1-dependent adhesion of rat ascites hepatoma AH66F to mesentery-derived mesothelial cells

Rat ascites hepatoma AH66F cells adhered better than AH130 cells to mesentery-derived mesothelial cells (M-cells), though both cells secreted Mr 92,000 matrix metalloproteinase on a gelatin zymogram with similar activity. AH66F cells expressed leukocyte function-associated antigen-1 (LFA-1) and intercellular adhesion molecule-1 (ICAM-1), a ligand of LFA-1, on the cell surface, while AH130 cells had ICAM-1 alone. The adhesion of M-cells of AH66F cells was inhibited to the adhesion level of AH130 cells by anti-rat LFA-1 alpha -and/or beta-chain monoclonal antibody (mAb) and also by anti-rat ICAM-1 mAb. This is the first report to show the LFA-1-dependent adhesion of cells other than leukocytes, because AH66F cells did not express CD45, T cell-alpha beta receptor or Cd11b/c (Mac-1/p150,95). These results indicate that a part of the adhesion of AH66F cells to M-cells is due to LFA-1/ICAM-1 interaction, and we suggest that this characteristic feature of AH66F cells may be related to the malignant properties.

Cytoplasmic calcium level and membrane fluidity of platelets contacting poly(acrylamide-co-methacrylic acid) particles with different surface properties

Changes in cytoplasmic free calcium levels and membrane fluidity of platelets in contact with poly(acrylamide-co-methacrylic acid) (PAAmMAc) particles were examined to analyze the mechanistic aspect of regulating platelet function. Our previous studies demonstrated interesting features of PAAmMAc particles during interaction with platelets: (1) PAAmMAc particles induce no calcium increase but enhance membrane fluidity of platelets: (2) thrombin induces no calcium increase in platelets when the platelets were mixed previously with PAAmMAc particles; and (3) PAAmMAc particles induce a calcium increase in platelets when they were treated previously with sodium azide (NaN3). These results suggest the possibility that PAAmMAc surfaces may regulate the calcium level by influencing platelet metabolism. In this study, non-cross-linked PAAmMAc solution with the same chemical composition as the particles showed a suppressive effect on thrombin-induced calcium increase, but, no influence on membrane fluidity. This result indicates that aggregated macromolecular surface assemblies of PAAmMAc may dominate the increase in membrane fluidity of platelets although the calcium change is induced by discrete molecular level interaction between the PAAmMAc and platelet membranes. It was also revealed that the suppression of thrombin-induced calcium increase and the membrane fluidity increase in platelets by PAAmMAc particles were reduced by albumin-treatment of the particles. This result suggests that such phenomena may be due to a decrease in any physicochemical interaction of PAAmMAc surfaces with albumin, rather than platelet metabolic change. PAAmMAc particle surfaces with higher carboxyl groups exhibited a more suppressive effect on thrombin-induced calcium increase, whereas those with lower carboxyl groups derived a higher calcium increase when the platelets were treated previously with NaN3. These results suggest the importance of electrostatic and any other physicochemical interaction of PAAmMAc chains on regulating cytoplasmic calcium levels.

Angiotensin-converting enzyme gene polymorphism in Japanese patients with hypertrophic cardiomyopathy

To examine the contribution of the angiotensin-converting enzyme (ACE) gene to hypertrophic cardiomyopathy (HCM), we determined the ACE insertion/deletion (I/D) polymorphism in 80 patients with HCM and 88 of their unaffected siblings and children. Patients were divided into familial or solitary HCM (FHCM or SHCM) groups with or without affected family members. Genotypes were identified by the polymerase chain reaction (PCR) with oligonucleotide primers flanking the polymorphic region in intron 16 of the ACE gene to amplify template DNA prepared from peripheral leukocytes. D-allele frequencies were 0.38 in all subjects, 0.42 in patients with HCM, and 0.35 in relatives (p < 0.05). The probability ratios were 1.98, 1.46, and 2.97 in patients with HCM, FHCM, and SHCM, respectively. The D allele frequency was higher in SHCM than in FHCM (p < 0.05). The findings suggest that HCM, especially in solitary cases, is partially determined by genetic disposition. Findings imply that the ACE D allele is one of the genetic contributing factors associated with cardiac hypertrophy in HCM.

Expression of renin and angiotensin-converting enzyme in human hearts

To understand the significance of the tissue renin-angiotensin system in the heart, we examined the expression of renin and angiotensin-converting enzyme (ACE) in autopsied human hearts. Samples were taken from organs obtained at autopsy from 15 patients without heart disease and 3 patients with heart disease (old myocardial infarctions, acute myocardial infarctions, and hypertrophic cardiomyopathy). We examined the expression of renin and ACE mRNA by using the reverse transcription-polymerase chain reaction (RT-PCR). RT-PCR showed the expression of renin in the right atria in all patients. However, expression of renin mRNA in the left ventricles was not found in any of the 15 hearts without heart disease. In contrast, renin mRNA was detected in the left ventricles in hearts with heart disease. ACE mRNA was detected in both the atria and the ventricles in normal hearts, and its expression did not alter in diseased hearts. These findings suggest that renin mRNA is expressed mainly in the right atria in normal hearts, but that its expression in the left ventricle can be activated in some pathological conditions.

[Ultrasonography of pediatric right lower abdominal pain: correlation with clinical and pathological results]

Right lower abdominal pain is a common problem in the pediatric population. Ultrasonography (US) is a well-accepted imaging modality in the clinical management of this problem. One hundred and six consecutive pediatric patients with right lower abdominal pain were prospectively evaluated. There were 54 boys and 52 girls, with ages ranging from 3 to 15 years (mean: 9.9 years). Final diagnoses were established based on pathological findings or clinical follow-up. US had sensitivity of 90%, specificity of 98%, and accuracy of 94% in the diagnosis of acute appendicitis. Among all true negative cases (n = 55), there was a variety of US findings other than appendiceal abnormality in 21 cases including intestinal and/or mesenteric (n = 19), gallbladder (n = 1), and ovarian (n = 1) abnormalities. All 21 cases were managed medically without complication. We conclude that US of pediatric right lower abdominal pain is a reliable imaging modality not only for the diagnosis of surgical cases but for eliminating the unexpected surgical intervention.

Acute myocardial infarction in a patient with primary coronary dissection and severe coronary vasospasm. A case report

A case of myocardial infarction associated with coronary artery dissection in a thirty-five-year-old woman is reported. An emergent coronary angiogram revealed extensive dissection and thrombosis in the right coronary artery; in addition, severe vasospasm was observed in the left coronary artery on the next day. She was successfully treated with intracoronary thrombolysis and intra-aortic balloon pumping. The patient is alive and well two years after infarction.

The secretory granule matrix-electrolyte interface: a homologue of the p-n rectifying junction

When placed at the tip of a glass micropipette electrode the polymeric matrix of the secretory granule behaves like a diode. The measured current was 100-fold greater at negative potentials compared to positive potentials, and up to sixfold greater than that measured with the pipette alone. By manipulating the geometry of the electric field we show that these electrical properties result from focusing an electric field at the gel-electrolyte interface. We also show, by using pulsed-laser imaging with fluorescein as the ionic probe, that there is a rapid accumulation and depletion of ions at the gel-electrolyte interface. A voltage pulse of -9 V applied to the gel caused a severalfold increase in the fluorescence intensity within 5 ms. This correlated with an increase in the measured current (approximately 1 microA). In contrast, within 5 ms of applying +9 V we recorded a decrease in the fluorescence intensity, which paralleled the twofold decrease in the measured current. This is similar to a p-n junction where an applied voltage causes the accumulation and depletion of charge carriers. Using synthetic gels (diameter 3-6 microns) with different charge characteristics we observed no rectification of the current with neutral gels and confirmed that rectification and amplification of the current were dependent on the fixed charge within a gel. In addition, we modeled the conduction at the gel-electrolyte interface using the Nernst-Planck electrodiffusion equation and accurately fitted the experimental current-voltage relationships. This study provides some insight into how biological interfaces may function. For example, we suggest that neurotransmitter release during exocytosis could be regulated by voltage-induced accumulation and depletion of ions at the interface between the secretory granule and the fusion pore.

The relationship between gastric secretion and type of early gastric carcinoma

To determine the relationship between gastric secretion and gastric carcinoma, we investigated gastric acid secretion and the fasting serum levels of pepsinogen I and gastrin in 50 Japanese patients with early gastric carcinoma. After the histological and macroscopic type of carcinoma had been determined, results were compared with findings in 50 Japanese control subjects whose gastric mucosa was endoscopically normal. The maximum gastric acid secretion and fasting levels of serum pepsinogen I were significantly lower in intestinal type gastric carcinoma than in diffuse type carcinoma and in the controls. They were also significantly lower in the non-ulcerative (elevated or flat) type than in the ulcerative (depressed) type of carcinoma. The serum gastrin levels in patients with early gastric carcinoma of either the intestinal or diffuse type were higher than those in the control subjects, though the difference was not significant. Gastric acid secretion and serum pepsinogen I levels were related with both the histological and macroscopic types of gastric carcinoma. These findings suggest that the serum pepsinogen I level might be useful as a maker for early gastric carcinoma of the intestinal type.

Role of endotoxin in wound healing impairment

We studied the effect of endotoxin on cutaneous wound healing and the mechanism involved. Rats underwent dorsal skin incision and subcutaneous placement of plastic nylon wound chambers. Immediately after this procedure, lipopolysaccharide (LPS) was administered intraperitoneally at doses of 1 to 10 mg/kg. In the rats given LPS at doses of 3 mg/kg or higher, the wound breaking strength and the production of hydroxyproline in the wound chambers were significantly reduced in a dose-dependent manner. The wound fluid serially collected from the wound chambers after surgery was examined for the effect on the growth of fibroblast. While the wound fluid from control rats showed a marked fibroblast growth-accelerating activity on postoperative day 7, this activity in the wound fluid from LPS-treated rats was significantly decreased. In the wound fluid from LPS-treated rats, the fibroblast growth-accelerating activity recovered to the control level by the addition of anti-TNF-alpha neutralizing antibody. These results suggested the following: wound healing is accelerated as a result of the production of fibroblast growth factor(s) in the site of the wound. The production of tumor necrosis factor-alpha (TNF-alpha) induced by endotoxin inhibits the effect of the growth factor(s) in the wound area, which results in decreased collagen production. Subsequently the wound healing process is impaired.

Low expression of adhesion molecules in a case of cutaneous T-cell lymphoma

A case of cutaneous T-cell lymphoma (CTCL) with low expression of the adhesion molecules lymphocyte function-associated antigen-1 (LFA-1), intercellular adhesion molecule-1 (ICAM-1), and very late antigen-4 (VLA-4) is described. The patient was a 90-year-old man with red round homogeneous tumors on his scalp, trunk, and extremities. He had no history of definite erythema or plaque stage. A biopsy sample taken from a tumor revealed massive infiltration of atypical lymphocytes in the reticular dermis and subcutis with a definite clear zone. The atypical lymphocytes were medium-sized with slightly convoluted nuclei. Immunohistochemically, the infiltrates showed the phenotype of so-called memory T cells. On the basis of these features, the case was diagnosed as CTCL. Expression of LFA-1, ICAM-1 and VLA-4 on the infiltrates was 9%, 13% and 11%, respectively, which is much lower than that in classic mycosis fungoides. This finding suggests that loss of these adhesion molecules may contribute to loss of epidermotropism in the advanced stage of CTCL.

[Electric gustatory threshold in diabetics and its clinical significance]

Electrogustometry was performed in diabetics and the correlation between the electric gustatory threshold and clinical factors of the patients (age, disease period and diabetic complications) were evaluated (n = 50). The results obtained were as follows: 1. The electric gustatory threshold rose with aging. The patient age range for further analysis was confined to 50 approximately 69 years old (n = 34) to exclude age dependency. 2. The patients with longer disease histories tended to show a higher electric gustatory threshold, indicating that taste abnormalities in diabetics progress with disease duration. 3. Elevation of the electric gustatory threshold in diabetics was observed before onset or at the earliest stage of the three major complications (diabetic neuropathy, retinopathy and nephropatho), and the threshold rose further with the progression of diabetic complications. Thus, the electric gustatory threshold is a sensitive indicator of diabetic nephropathy and was demonstrated to be a remarkably useful indicator for the prevention of diabetic complications, since it allows detection of the three major diabetic complications at their earliest stages.

Transcriptional induction of prostaglandin G/H synthase-2 by basic fibroblast growth factor

In serum-free mouse osteoblastic MC3T3-E1 cells, basic fibroblastic growth factor (bFGF) induced mRNA and protein for prostaglandin G/H synthase-2 (PGHS-2), the major enzyme in arachidonic acid (AA) conversion to prostaglandins. mRNA accumulation peaked at 1 h with bFGF 1 nM. In cells stably transfected with a 371-bp PGHS-2 promoter-luciferase reporter, bFGF stimulated luciferase activity, which peaked at 2-3 h with bFGF 1-10 nM. In the presence of exogenous AA, bFGF stimulated PGE2 production, which paralleled luciferase activity. In serum-free neonatal mouse calvarial cultures, bFGF stimulated PGE2 production in the absence of exogenous AA. bFGF stimulated PGHS-2 mRNA accumulation, which peaked at 2-4 h and then decreased; there were later mRNA elevations at 48 and 96 h that were inhibited by indomethacin. In both MC3T3-E1 cells and neonatal calvariae, bFGF produced smaller and slower increases in PGHS-1 mRNA levels than for PGHS-2. bFGF stimulated bone resorption in mouse calvariae with a maximal increase of 80% at 1 nM. Stimulation was partially inhibited by nonsteroidal anti-inflammatory drugs. We conclude that bFGF rapidly stimulates PGE2 production in osteoblasts, largely through transcriptional regulation of PGHS-2, and that prostaglandins mediate some of bFGF's effects on bone resorption.

Macrophages in childhood IgA nephropathy

The role of glomerular macrophages in IgA nephropathy in children was investigated using a new monoclonal antibody (KP1) as a probe. The average number of glomerular macrophages per patient (ANM/P) was closely correlated with the degree of hematuria (P < 0.01) as well as with the degree of leukocyturia (P < 0.01) in the absence of any correlation with proteinuria, serum IgA levels or the interval between the detection of urine abnormalities and renal biopsy. ANM/P was significantly higher in patients diagnosed pathologically as having focal and diffuse proliferative glomerulonephritis than in patients with minor glomerular abnormalities or advanced sclerosis (P < 0.05). Among various types of glomerular morphology in individual patients, macrophages predominantly infiltrated glomeruli with cell-proliferative lesions despite an absence of any increase in glomeruli with minor abnormalities or with sclerosis. Macrophages were mainly localized within the capillary lumen in association with endocapillary proliferative lesions (tuft necrosis), they accumulated in areas of mesangial proliferation, and they were attached to Bowman's capsule in segmental lesions. Macrophages were less evident in sclerosis. Furthermore, ultrastructural analysis revealed macrophages in the paramesangial areas in close proximity to lytic changes in the glomerular basement membrane and effacement of epithelial foot processes. In addition, some cases in repeat biopsy shows prolonged or increased values of ANM/P after several years of interval in association with progression of proliferative lesions. These results suggest that macrophages infiltrate glomeruli during acute glomerular inflammation, and that they are involved in mesangial proliferation or the development of extracapillary lesions in the absence of apparent clinical symptoms. Furthermore, recurrence or prolonged infiltration may promote progression of IgA nephropathy.

[Serum levels of soluble receptors for tumor necrosis factor in sarcoidosis]

Tumor necrosis factor alpha (TNF-alpha) has been shown to play an important role in granulomatous diseases, including sarcoidosis. TNF-alpha starts affecting cell function by binding to specific, high-affinity receptors on the cell surface, and two types of TNF-alpha receptors have been identified. Recently, soluble forms derived these cell surface receptors (sTNF-R type I and type II) have been shown to exist and have been investigated in several diseases. The levels of sTNF-R type I and type II in serum from patients with sarcoidosis were measured, and the clinical significance of sTNF-R was evaluated. The levels of both sTNF-R type I and type II were significantly higher in serum from patients with sarcoidosis (n = 36) than in serum from control subjects (n = 15): type I, 1.93 +/- 1.28 ng/ml vs 1.31 +/- 0.40 ng/ml, p < 0.01; type II, 3.48 +/- 2.60 ng/ml vs 1.56 +/- 0.35 ng/ml, p < 0.001. The levels of these receptors were significantly higher in patients with active sarcoidosis than in those with inactive sarcoidosis: type I, 2.43 +/- 1.83 ng/ml vs 1.57 +/- 0.45 ng/ml, p < 0.05; type 4.71 +/- 2.24 ng/ml vs 2.25 +/- 0.77 ng/ml, p < 0.01. The levels of sTNF-R type I and type II correlated significantly with the level of ACE, r = 0.70, p < 0.01; and r = 0.55, p < 0.05, respectively. We conclude that measurement of the levels of both types of sTNF-R may be useful in the evaluation of disease activity in sarcoidosis.

ABO incompatible kidney transplantation in children

We have performed 7 pediatric kidney transplantations from living related donors of ABO incompatibility. All patients preoperatively underwent plasmapheresis with or without immunoadsorption to reduce anti-A and/or anti-B antibodies. Immunosuppression initially consisted of methylprednisolone, cyclosporine, azathioprine, antilymphocyte globulin and deoxyspergualin. At transplantation splenectomy was simultaneously performed in all patients. Median followup is 44 months (range 31 to 58). Patient and graft survival rates are 100% to date. There were no uncontrollable vascular rejection episodes, and post-transplant anti-A and/or anti-B antibody titers were always less than 1:32. Transplantation across the ABO blood barrier remains challenging today. However, our small series clearly shows that the preoperative reduction of ABO antibody, simultaneous splenectomy and strict immunosuppressive therapy cause successful long-term results in children.