Progressive systemic sclerosis preceded by malignant lymphoma

We report a patient who suffered from progressive systemic sclerosis (PSS) two years after she showed evidence of malignant lymphoma of the jejunum. Surgical resection of the tumor mass and VEMP regimen were successful; the patient was in remission but died of acute respiratory failure five years later. Although several reports have reported malignant lymphoma associated with PSS, lymphoma antecedent to PSS is rarely seen. Immune abnormalities including a high titer of antinuclear factor and positive anti-RNP antibodies were suspected to be associated with the development of PSS in our case.

[The spread of hepatitis C markers among the population of regions of Russia and Central Asia]

A total of 2,217 blood serum samples taken from the population of some regions of the former USSR were studied for the presence of antibodies to hepatitis C virus (HCV) with the use of a commercial enzyme immunoassay system (obtained from Ortho, Japan). Perceptible changes in the detection rate of these antibodies throughout the territory of the former USSR were established. Most frequently anti-HCV antibodies were detected among the population of the republics of Central Asia (5.3-2.9%), as well as Tuva and Yakutia (2.5-3.0%), their lowest detection rate was in Moscow (1.3%). In Moscow the results of the assay in adults were positive twice as frequently as in children, and in donors with an elevated level of alanine-transferase activity the presence of these antibodies was confirmed in 8.9% of cases. The frequency of the confirmation of the presence of anti-HCV antibodies by recombinant immunoblotting was 70.7% in all positive sera and 100% in the sera from a group of donors with an elevated enzyme level. In many respects coincidence between the regularities in the spread of viral hepatitic C and hepatitides B, D was noted.

[Hyperuricemia and atherosclerosis]

To clearly determine whether hyperuricemia participates directly in atherosclerotic disease or not, the prognosis and associated factors were studied, based on data from 104 patients whose serum uric acid had been completely maintained at normal levels with prolonged medication. The mean age at death was 65.8 +/- 10.5 years. The causes of death were as follows: cardiovascular disease (26.9%), cerebral disease (26.2%), malignant neoplasms (26.0%), uremia (7.6%), and miscellaneous disease (18.3%). Serum lipids especially triglycerides, body weight and influenced on the prognosis of the patients FBS. Most common complications were in the cardiovascular disease group; hypertension and hyperlipidemia. These data suggested that the apparent increased incidence of cardiovascular disease in gout rather than renal failure bore a relationship to such complications as hypertension or hypertriglycemia. Hyperuricemia alone may not be an atherosclerotic risk factors. There was no correlation between treatment with allopurinol and probenecid and cardiovascular complications.

The correlation of response with plasma pharmacokinetics and polyamine concentrations in patients with acute myelogenous leukemia receiving amonafide

We have investigated the correlation of clinical responses (decreases of white blood cells and peripheral blasts) with pharmacokinetic and pharmacodynamic parameters in patients with acute myelogenous leukemia who are receiving amonafide. The increase of plasma polyamine concentrations was used as a measure of tumor sensitivity (pharmacodynamic effect). The correlations between pharmacokinetic parameters (biological half life, area under the concentration time curve (AUC), total plasma clearance), decreases of total white blood cells and peripheral leukemic blasts were weak (maximum r = 0.47). Correlations of response with polyamines were better than those with pharmacokinetic parameters, but not exceptional; of these, the best correlations were with the increase of putrescine. On the other hand, correlations of combinations of AUC and increases of plasma polyamine concentrations with decreases of total white blood cell counts approached unity. Unexpectedly, decreases of peripheral leukemic blasts were correlated just as well with putrescine increase alone (r = 0.91, P = 0.003) or with a combination of polyamine increases and AUC (r = 0.92, P = 0.036).

Detection and epitope analysis of autoantigen-reactive T cells to the U1-small nuclear ribonucleoprotein A protein in autoimmune disease patients

T cells that recognize autoantigens might play an important role in autoimmune diseases. To analyze "autoantigen-reactive T cell" in patients with an autoimmune disease, a human lymphocyte proliferation assay using soluble recombinant autoantigens has been conducted. PBMC from mixed connective tissue disease and SLE patients who possessed anti-U1-small nuclear ribonucleoprotein (snRNP) A autoantibodies responded to a recombinant U1-snRNP A protein. In contrast, PBMC from healthy subjects or autoimmune disease patients not possessing anti-U1-snRNP A autoantibodies did not show such responses. In addition, this proliferative response was inhibited by anti-CD4 mAb. Limiting dilution analyses revealed that the autoantigen-reactive T cells exist in relatively high frequency (1 of 4,065 to 1 of 23,256) in the mixed connective tissue disease patients. Moreover, by T cell epitope mapping, the T cell epitope area was found to be located in the C-terminus of the U1-snRNP A protein, overlapping the B cell epitope area that has been reported. These findings suggest the presence of autoantigen-reactive T cells in such patients, and when these T cells are activated, they may play a central role in the autoantibody generation.

Detection and epitope analysis of autoantigen-reactive T cells to the U1-small nuclear ribonucleoprotein A protein in autoimmune disease patients

T cells that recognize autoantigens might play an important role in autoimmune diseases. To analyze "autoantigen-reactive T cell" in patients with an autoimmune disease, a human lymphocyte proliferation assay using soluble recombinant autoantigens has been conducted. PBMC from mixed connective tissue disease and SLE patients who possessed anti-U1-small nuclear ribonucleoprotein (snRNP) A autoantibodies responded to a recombinant U1-snRNP A protein. In contrast, PBMC from healthy subjects or autoimmune disease patients not possessing anti-U1-snRNP A autoantibodies did not show such responses. In addition, this proliferative response was inhibited by anti-CD4 mAb. Limiting dilution analyses revealed that the autoantigen-reactive T cells exist in relatively high frequency (1 of 4,065 to 1 of 23,256) in the mixed connective tissue disease patients. Moreover, by T cell epitope mapping, the T cell epitope area was found to be located in the C-terminus of the U1-snRNP A protein, overlapping the B cell epitope area that has been reported. These findings suggest the presence of autoantigen-reactive T cells in such patients, and when these T cells are activated, they may play a central role in the autoantibody generation.

Overgrowth of human synovial cells driven by the human T cell leukemia virus type I tax gene

One of the salient pathological features of rheumatoid arthritis is synovial cell proliferation with bone erosion. Despite extensive investigation, the factors essential for synovial cell proliferation remain to be identified. Recent studies suggest that human T cell leukemia virus type I (HTLV-I) may play an important role in synovial overgrowth observed in patients with one type of chronic inflammatory synovitis. In order to confirm and extend these observations, we have established synovial cell clones (SCCs) from three HTLV-I carriers who demonstrated synovial overgrowth but were otherwise asymptomatic. HTLV-I proviral DNA randomly integrated into the cellular genome was present in 20-30% of SCCs. The SCCs carrying HTLV-I proviral DNA and expressing the tax gene exhibited high levels of proliferative potential. HTLV-I was found to function as a transcriptional trans-activator in these SCCs. Moreover, transfection of the tax expression plasmid into SCCs resulted in the same phenotype of increased proliferation and cytokine expression as exhibited by HTLV-I provirus-carrying and tax-expressing SCCs. These data suggest that tax plays a critical role not only in leukemogenesis but also in synovial overgrowth in humans.

Analysis of 70 KD heat shock protein (HSP70) expression in the lesional skin of lupus erythematosus (LE) and LE related diseases

Biopsied specimens from skin lesions of SLE were studied for expression of 70 KD heat shock protein (HSP70). The pattern of HSP70 expression in SLE was diffuse in whole epidermis, hair follicles, and sweat gland cells and rather more intense than that in other control groups or normal skin. No significant differences in HSP70 expression were observed between sun-exposed and protected areas of SLE skin lesions. Unlike SLE, reduced or no expression of HSP70 was observed in skin lesions of DLE. In tissue culture, UVB radiation in vitro induced relatively intense expression of HSP70 in the nuclear area of keratinocytes. A few gamma delta T cell receptor positive cells which might respond to HSP70 expressing cells were detected in the basal layer of skin lesions of diseases. These studies suggest that aberrant expression of HSP70 in skin lesions of SLE might contribute to both skin lesions and antibody formation in SLE.

A new variant of punctate acrokeratoderma associated with a pigmentary disorder

We report a Japanese patient with skin-coloured keratotic papules on the hands and feet, and pronounced hyperkeratosis of the palms and soles. There was no evidence of fragmentation of dermal elastic tissue on histology. Freckle-like pigmentation was also present on the dorsa of the hands and feet, and this appeared to be closely related to the keratotic disorder. The mode of inheritance was autosomal dominant. We consider our case to be a new variant of familial punctate acrokeratoderma, associated with a pigmentary disorder.

Seasonal change in maximal expiratory flow-volume pattern in patients with Japanese cedar pollenosis

Fifteen patients with Japanese cedar pollenosis were examined for lower airway function. Flow-volume patterns obtained from flow-volume and volume-time curves during the pollen season (March) and outside of the pollen season (June) were evaluated. In a previous report we classified maximal expiratory flow-volume (MEFV) curves in five patterns from A to E. In the present study, the patterns did not vary between the two periods except in one patient. Eleven patients out of 15 showed type E patterns, in which the flow-volume curve was concave along its entire course. In most of the patients with severe or moderate symptoms of allergic rhinitis only during the pollen season, the curve shifted to the right, but the parameters of the curves did not increase significantly outside of season. These findings suggest that patients with Japanese cedar pollenosis suffer from continuous latent peripheral airway obstruction. Extremely slight changes in the flow rate were detected by comparing the curves obtained during the two periods.

A comparison of induced heat-shock protein in neurons destined to survive and those destined to die after transient ischemia in rats

We examined the induction of heat-shock protein (HSP) in CA-1 pyramidal neurons compared with that in CA-3 pyramidal neurons, in rat brain following 20 min of ischemia. The time course of the changes of localization of HSP was investigated using immunohistochemical and Western blot analyses. The induction of HSP in the CA-1 subfield was the same as that in the surviving hippocampal CA-3 subfield.

Rheumatic manifestation of human leukemia virus infection

Rheumatic disorders associated with retroviruses are described in this article. A recent study of human T-cell leukemia virus type-I (HTLV-I) revealed that it appeared to be associated with the pathogenesis of several immune disorders such as myelopathy, broncho-pneumopathy, Sjogren's syndrome, and arthropathy. HTLV-I-associated arthropathy (HAAP) shows remarkable synovial proliferation with nuclear convoluted T-cell infiltration in both synovium and synovial fluid. Synovial cells obtained from HAAP patient-integrated HTLV-I proviral DNA and also expressed mRNA for HTLV-1 tax gene; moreover, HTLV-1 integrated synovial cell clones expressed a high level of mRNA for several oncogene and growth factors compared with HTLV-I non-integrated clones. These findings suggest that HTLV-I is the first exogenous retrovirus that contributes to synovial proliferation with immune disorders in humans.

Clinical staging and gadolinium-DTPA enhanced images of the wrist in rheumatoid arthritis

The usefulness of gadolinium (Gd)-DTPA enhanced magnetic resonance imaging (MRI) of the wrist joint for predicting articular destruction was investigated in 49 patients with rheumatoid arthritis (RA). On T1 weighted images with Gd-DTPA enhancement, the synovium showed a localized or diffuse pattern of enhancement. Many patients classed as stage II or higher by plain radiography had diffuse enhancement on MRI, while all except one stage I patient had relatively confined localized enhancement. Our study showed that MRI of the carpus could detect soft tissue changes in patients with RA earlier than anything revealed by radiography, and suggested that contrast MRI may be useful for predicting articular destruction.

B cell epitope on the U1 snRNP-C autoantigen contains a sequence similar to that of the herpes simplex virus protein

The mechanism of autoantibody production in autoimmune diseases is not well understood. In the present study we performed the B cell epitope mapping of the U1 small nuclear ribonucleoprotein (snRNP)-C, one of the target molecules of anti-nRNP autoantibody to investigate how B cells respond to the autoantigen. After cloning and expression of a full length complementary DNA (cDNA) encoding the U1-C protein, several truncated mutants of the cDNA were constructed and expressed in E. coli. Although a few epitopes were distributed on the whole molecule, all anti-C protein antibody-positive patients' sera tested recognized the region between amino acid residues 102 and 125 of the coding sequence. This universal epitope region contains an amino acid sequence similar to that of the herpes simplex virus type 1 ICP4 protein. The peptides representing each molecule were cross-reactive to each other. In addition this region cross-reacted to the B/B' protein. These observations suggest that molecular mimicry might be involved in the initiation of autoantibody production, followed by cross-reactive events between the autoantigens and by antigen-driven mechanisms to generate more complicated autoantibody patterns against the U1 snRNP complexes.

[Studies on screening for hard-of-hearing children by questionnaire. 2. Comparison of response rates to individual questions in 1-year-6-month-old children with normal hearing and hearing loss using a health screening questionnaire]

We report the results of studies on responses to questions on hearing impairment, comparing 165 school children whose hearing was diagnosed as normal at the time of admission to primary school and 37 children with hearing loss attending facilities for children with this disability. These children had been covered by similar surveys as part of the health screening for 1-year-6-month-old infants conducted by municipal authorities. Significant differences between the two groups were noted in the response rates to all questions on hearing. Similar differences were noted in the responses to questions on family history of hearing impairment. There were no significant differences in the incidences of asphyxia and jaundice at birth. The most striking differences were noted in the response rates to questions 6, 7, 8, 10, 11, 16, and 18. Most useful and universally valid in this survey were questions 8, 10 and 18 in addition to the question on whether or not parents suspected infantile hearing loss.

Giant mucocele of oral cavity as a mucocutaneous manifestation of Sjögren syndrome

Two cases of Sjögren syndrome who developed a giant mucocele on the floor of the oral cavity are reported. Histological analysis revealed the dense infiltration of lymph-plasmacytic infiltration around the dilated salivary duct. Similar findings were observed in the biopsied specimens of the labial salivary gland which were consistent with the grade 4 score proposed by Chisholm and Mason's criteria. Mucocele is a common mucocutaneous disease of unknown etiology except for traumatic origin and Sjögren syndrome might be one of the important underlying disease which causes giant mucocele, especially in elderly female patients.

Low temperature dependent IgG3 subclass antibody with low avidity to C100-3 antigen derived from hepatitis C virus in voluntary blood donors

The presence of an antibody which reacts strongly at lower temperatures to C100-3 antigen derived from the hepatitis C virus (HCV) was demonstrated in blood donors' sera. These sera reacted with the antigen most strongly at 4 C and most weakly at 37 C and are termed 'cold antibody group'. The cold antibody group reaction was specifically inhibited with soluble C100-3 antigen. Cold antibody bound to C100-3 antigen at 4 C was dissociated at 37 C and was isolated in this manner. Low temperature-dependent anti C100-3 antibody was shown to be predominantly IgG3 subclass by ELISA using anti-human IgG subclass antibody. This IgG3 antibody was dissociated from antigen with 6M urea, demonstrating its low avidity. HCV-RNA was demonstrated in two of five samples. Therefore, to achieve more effective prevention of post-transfusion hepatitis C, we propose the incorporation of programs to detect low temperature-dependent low-avidity antibody against HCV-related antigen.

Eosinophil cationic protein in the nasal secretions of patients with mite allergic rhinitis

In 25 patients with mite nasal allergy and 13 healthy control subjects, levels of eosinophil cationic protein (ECP) and histamine in nasal secretions were examined before and after challenge with mite extract. The ECP level was found to be significantly higher in the washings taken 30 minutes after challenge compared with the washings taken before challenge (P < .05). ECP levels measured both before and after mite extract challenge were found to be significantly higher in the patients than in the controls (P < .01). These facts suggest that the ECP affects the nasal mucosa by causing injury to ciliated cells and by acceleration of the processes of modification and inhibition of the allergic reaction.

Iatrogenic benign lymphoplasia induced by allergic contact dermatitis from squaric acid dibutylester: immunohistologic study of cellular infiltrates

We report of a 62-year-old male patient with a dull red itchy nodule on the induction area of allergic contact dermatitis to squaric acid dibutylester, which had been used for the therapy of alopecia universalis. The excised biopsy specimen showed dense infiltration of lymphoid cells in the dermis and subcutaneous tissue, associated with the formation of lymphoid follicles. Immunohistologic analysis of the infiltrates indicated mixed proliferation of T- and B-cells. A biopsy specimen from the challenge area showed spongiosis in the epidermis and lymphoid cell infiltration in the upper dermis, while the infiltrates consisted mainly of T-cells. The following points are discussed: (i) the lesion had an iatrogenic origin and the causative agent was quite evident; (ii) the route of allergen application was only through the epidermis and not directly in the dermis; (iii) lymphoid cell infiltrates of the induction and challenge areas were different.

Uptake of acetylated low density lipoprotein (ac-LDL) by synovial cells

Acetylated low density lipoprotein (ac-LDL) is known to be incorporated into monocyte/macrophages. We examined the uptake of fluorescence-labeled ac-LDL as well as the surface expression of CD14 using flow cytometry, in order to identify macrophage-like type A synoviocytes in the synovium of patients with rheumatoid arthritis (RA) (n = 15) and osteoarthritis (OA) (n = 5). The mean (+/- SD) percentage of ac-LDL uptake cells in RA synoviocytes (38.3 +/- 19.9%) was relatively higher than that in OA synoviocytes (16.6 +/- 8.7%) (p < 0.05). Also the proportion of ac-LDL incorporating cells paralleled, but was higher than, that of CD14 positive cells (r = 0.91, p < 0.001). This method is helpful in determining macrophage-like type A synoviocytes, and the presence of CD14-negative macrophage-like synoviocytes has been revealed.

Induction and characterization of mast cell colonies by culture supernatant of retinoic acid-treated mouse keratinocytes

The retinoic acid-stimulated mouse-transformed epidermal cell line Pam 212 generated soluble mediators (RA-Pam sup) which showed mast cell-proliferating activity and induced mast cell-like colonies from bone marrow cells. Both mucosal-type and connective tissue-type mast cells were demonstrated on histochemical analysis. The 3T3 fibroblast cell line or human trichilemmomal cell line (TL1) also generated similar molecules on retinoic acid stimulation. Anti-stem cell factor antibody presented a rather more potent inhibitory activity on RA-Pam sup-dependent mast cell colony formation than did anti-IL3 and -IL4 antibodies. RA-Pam sup only induced mast cell colonies in semisolid culture and failed to promote mast cell growth in a suspension culture. In addition, mast cell colonies showed close contact with fibroblast-like cells on the methylcellulose plate, but this finding was not observed in culture without RA-Pam sup.