Serum concentration of the pyridinoline cross-linked carboxyterminal telopeptide of type I collagen (ICTP) is a useful indicator of decline and recovery of bone mineral density in lumbar spine: analysis in Japanese postmenopausal women with or without hormone replacement

To reassess the clinical utility of serum pyridinoline cross-linked carboxyterminal telopeptide of type I collagen (ICTP), a promising but controversial indicator of bone resorption, we evaluated its performance as a biochemical marker in a 6-month study of a strictly selected population of 76 Japanese postmenopausal and healthy women, 33 recipients of hormone replacement therapy and 43 nonrecipients. We measured bone mineral density (BMD) of the lumbar spine (L2-L4), and serum ICTP, carboxyterminal propeptide of type I procollagen (PICP) and other conventional serum biochemical markers, e.g. bone gla protein (BGP), alkaline phosphatase, calcium and phosphate at the entry and 6 months later. We calculated the percent change between the baseline and 6-month values (delta%) in lumbar BMD and the biochemical markers, individually, and compared the degree of correlations between delta% in BMD and that in the biochemical markers. Delta% in ICTP and delta% in BGP correlated with delta% in BMD negatively and significantly. Especially delta% in ICTP correlated with that in BMD to a high degree (P<0.0001). No significant correlation was observed in other biochemical markers. We concluded that serum ICTP is a sensitive and useful bone resorption marker in the postmenopausal population, which strongly correlates with the change in BMD.

Spheroid formation of hepatocytes using synthetic polymer

It is known that hepatocytes show the different morphology depending on the surface condition of cultural substratum. The cells form a floating cell-aggregate called spheroid on proteoglycan-coated or positively charged dishes. The liver cell functions are generally high and maintained for the long-term in the spheroid culture. Since spheroid morphology is preferable for the construction of a bioartificial liver, it is important to develop an effective method of preparing spheroids. In this regard, we examined a preparation method of functional spheroid-like cell-aggregates, in which a synthetic polymer, Eudragit was added to culture medium for inducing liver cell-aggregation. The cell-cell attachment of the aggregate was loose at the beginning of the culture, but it became tight and spheroids were formed 2-3 days after inoculation. When 0.1% Eudragit was added to the medium, the liver functions such as albumin secretion, ammonia removal and urea synthesis were enhanced compared with monolayer and conventional spheroid cultures. The spheroid formation was also performed with suspension culture in a spinner flask. Approximately 80% of the cells inoculated formed spheroids by the addition of the polymer. Moreover, the polymer showed a protective effect from cell damage by agitation. Since this procedure does not require surface for cell attachment, a large amount of spheroids can be prepared in suspension culture.

Identification of chondromodulin I as a novel endothelial cell growth inhibitor. Purification and its localization in the avascular zone of epiphyseal cartilage

Cartilage is unique among tissues of mesenchymal origin in that it is resistant to vascular invasion due to an intrinsic angiogenic inhibitor. During endochondral bone formation, however, calcified cartilage formed in the center of the cartilaginous bone rudiment allows vascular invasion, which initiates the replacement of cartilage by bone. The transition of cartilage from the angioresistant to the angiogenic status thus plays a key role in bone formation. However, the molecular basis of this phenotypic transition of cartilage has been obscure. We report here purification of an endothelial cell growth inhibitor from a guanidine extract of bovine epiphyseal cartilage. The N-terminal amino acid sequence indicated that the inhibitor was identical to chondromodulin I (ChM-I), a cartilage-specific growth-modulating factor. Purified ChM-I inhibited DNA synthesis and proliferation of vascular endothelial cells as well as tube morphogenesis in vitro. Expression of ChM-I cDNA in COS7 cells indicated that mature ChM-I molecules were secreted from the cells after post-translational modifications and cleavage from the transmembrane precursor at the predicted processing signal. Recombinant ChM-I stimulated DNA synthesis and proteoglycan synthesis of cultured growth plate chondrocytes, but inhibited tube morphogenesis of endothelial cells. In situ hybridization and immunohistochemical studies indicated that ChM-I is specifically expressed in the avascular zone of cartilage in developing bone, but not present in calcifying cartilage. These results suggest a regulatory role of ChM-I in vascular invasion during endochondral bone formation.

Multiple endocrine neoplasia type 1 is not rare in Japan

Multiple endocrine neoplasia type 1 (MEN 1) is rarely reported in Japanese and other oriental populations. To examine if there is a racial difference in the prevalence of MEN 1, we initiated extensive work on patients with endocrine tumors for additional lesions, and annual screening of family members of affected patients. In a four-year study, eleven asymptomatic patients were found by family screening, and the number of patients with MEN 1 in our clinics increased from 16 to 38. Estimated prevalence of MEN 1 was no less than 0.018/1000. MEN 1 may not be as rare as had been thought in Japanese, and the prevalence of MEN 1 in Japanese would not be significantly different from that of Caucasians. Systemic surveillance and extensive screening of family members are required for early detection and management of patients.

Gianotti-Crosti syndrome associated with cytomegalovirus antigenemia after bone marrow transplantation

Gianotti-Crosti syndrome (GCS) is characterized by a distinctive self-limiting acral papular or papulovesicular eruption associated with an underlying viral illness. It has not been previously reported in patients post-bone marrow transplantation. We report a 6-year-old Japanese boy who underwent allogeneic bone marrow transplantation from an unrelated donor for acute lymphoblastic leukemia (ALL) in second remission. He had clinical and histopathologic findings characteristic of GCS and evidence of subclinical infection with cytomegalovirus (CMV) detected by CMV antigenemia assay. It is likely that CMV is the causative agent for the GCS in this case.

Papillary eccrine adenoma: immunohistochemical studies of keratin expression

Despite various studies, there are serious disagreements about the cellular differentiation of papillary eccrine adenoma. In the present study, 2 specimens of papillary eccrine adenoma were analyzed by immunohistochemical techniques, using a panel of monoclonal antibodies against keratins, to elucidate its differentiation. Histopathologically, the tumor was composed of multiple tubular structures lined by two or more layers of epithelial cells. The luminal cells of the tubules were flattened or cuboidal. The former were noted in large dilated tubules. The latter were usually observed in small-to-moderate-sized tubules, and formed intraluminal papillary projections in some tubules. Immunohistochemically, there were two kinds of cuboidal cells in the luminal layers of the tubules. Most of the large dilated tubules and some of the small-to-moderate-sized tubules expressed immunophenotypes similar to those of the eccrine dermal duct. The other tubular structures, including the small tubules resembling those of syringoma, expressed immunophenotypes similar to those of the transitional portions between the dermal ducts and the secretory segments of eccrine glands. From the above comparative studies, papillary eccrine adenoma is considered to differentiate towards the dermal duct and the transitional portions between the dermal ducts and the secretory segments of eccrine glands.

Human IgGFc binding protein (FcgammaBP) in colonic epithelial cells exhibits mucin-like structure

Cloning a cDNA for human IgGFc binding protein (FcgammaBP) from human colonic epithelial cells reveals an mRNA and coding region of 17 and 16.2 kilobases, respectively. The predicted amino acid sequence contains 12 occurrences of a 400-amino acid cysteine-rich unit resembling that found in mucin. A motif (CGLCGN) in FcgammaBP is conserved in MUC2 and prepro-von Willebrand factor. The N-terminal 450-amino acid sequences are necessary and sufficient to confer IgG Fc binding activity. FcgammaBP mRNA is expressed only in placenta and colonic epithelial cells. These results suggest that FcgammaBP may play an important role in immune protection and inflammation in the intestines of primates.

Peripheral blood neutrophil rheology measured by micropore filtration reflects Behçet's disease activity well

Activated neutrophils take a long time to pass through a narrow lumen like a micropore, and are supposed to play a deteriorating effect on microcirculation. Although the activation of neutrophils has been demonstrated in Behçet's disease, nobody analyzes the clinical activity of the disease by means of the rheological measure of neutrophils activity. Using a micropore (pore diameter 5 microns) filtration technique, we measured the filtration time of peripheral blood neutrophils, as a rheological measure of their activity, in order to determine the clinical activity of Behçet's disease. Twenty-one patients with Behçet's disease and 14 healthy control individuals were enrolled in the study. Symptoms and signs exhibited in the patients led us to distinguish the Behçet's disease into inactive and active cases. The latter were further differentiated into cases with absent symptoms and with present symptoms. Neutrophil filtration times were 11.5 +/- 4.8 s in the active cases with present symptoms, which were significantly (P < 0.05) larger than those (7.4 +/- 1.9 s) in the active cases with absent symptoms. The latter filtration times were further significantly (P < 0.001) larger than values (3.7 +/- 1.3 s) in the inactive cases and also those (4.8 +/- 1.2 s) in control subjects. Furthermore, increases in the filtration time obtained immediately after the exposure of cells to the chemotactic peptide formyl-methionyl-leucyl-phenylalanine (FMLP: 10 nM) were significantly (P < 0.01) larger in the active cases with present symptoms than those in the active cases with absent symptoms. The latter were also larger, but not significantly, than those in the inactive cases, and were significantly (P < 0.01) larger than those in control subjects. The present results demonstrate that the micropore filtration method reflects well the rheological activity of neutrophils as well as the clinical status of Behçet's disease. This method is much better than the measurement of O2 production to differentiate between active cases with absent symptoms and inactive patients or even control individuals. Furthermore, it is more sensitive and useful than laboratory data like the CRP value or the number of peripheral blood neutrophils.

[Swallowing rehabilitation in an elderly patient with Wallenberg's syndrome--role of videofluorography and the swallowing provocation test]

A 65-year-old man was admitted to our department due to severe dysphagia, dysarthria, and aspiration pneumonia. Dysphagia and dysarthria were caused by lateral medullary infarction (Wallenberg' s syndrome). After the patient recovered from pneumonia, the abnormality of swallowing was assessed by a swallowing provocation test and videofluorography. Two months after the start of swallowing training, a swallowing provocation test showed that the swallowing reflex had improved and videofluorography showed that the magnitude of aspiration to the trachea had decreased. The patient began taking food by mouth. These tests are useful for quantitative assessment of dysphagia and for deciding when to start oral intake in elderly patients.

Role of supplementation of a nucleic acid solution on the intestinal mucosa under total parenteral nutrition

Since dietary nucleotides play an important role in the growth and development of the intestine, supplementation of a nucleic acid solution (OG-VI) may support the optimal growth and integrity of the intestine under total parenteral nutrition (TPN). Supplementation of OG-VI to a TPN solution improved mucosal morphologic and functional changes, increased mucosal proliferation, and decreased mucosal permeability of the intestine. After 80% small bowel resection, OG-VI supplementation to a TPN solution attenuated the initial mucosal atrophy and improved intestinal cell turnover. Nucleic acid supplementation may be clinically beneficial in certain situations.

Influence of pepsinogen gene polymorphisms on serum pepsinogen

We identified pepsinogen C (PGC) gene polymorphisms by means of PCR, which amplified DNA in the region within the intron between exons 7 and 8, and by 6% polyacrylamide gel electrophoresis. Six alleles were found in a Japanese population. The frequencies of these alleles in 408 unrelated Japanese individuals were 0.074, 0.026, 0.335, 0.237, 0.016 and 0.314, respectively. The serum pepsinogen II level significantly decreased in the order of the allele 6 homozygote, the allele 6 heterozygote and the other genotypes (chi 2 = 7.850, D.F. = 2, p = 0.020). These findings indicated that the genetic background of serum pepsinogen should be considered when screening for stomach cancer by this procedure.

Effects of nucleosides and a nucleotide mixture on gut mucosal barrier function on parenteral nutrition in rats

BACKGROUND

We have previously reported that the addition of nucleosides and a nucleotide mixture (OG-VI) to total parenteral nutrition (TPN) prevents TPN-induced intestinal mucosal atrophy and results in increased intestinal cathepsin activities under TPN. The aims of the present study are to examine the effects of OG-VI on mucosal barrier functions and to clarify whether the intestinal cathepsins can be used as a new marker of mucosal barrier function.

METHODS

Male Wistar rats were divided into three groups: FED (food ad libitum), TPN (a standard TPN solution), and OG (OG-VI in addition to the TPN solution). Mucosal barrier functions were analyzed by the lactulose/mannitol (L/M) test, mucosal ZO-1 messenger RNA level, and electron micrographs in the gut. Intestinal cathepsin B, H, and L activities were also measured.

RESULTS

The L/M ratio for TPN was much higher than that for FED. Only lactulose excretion was significantly reduced by OG-VI. The intercellular spaces of the mucosal cells for TPN were significantly wider than those for FED, but were reduced in size by the addition of OG-VI. All cathepsin activities of the ileum were higher for TPN than for FED, whereas OG showed no increase.

CONCLUSION

OG-VI contributes to the improvement of gut mucosal barrier function. Intestinal cathepsin activities can be used as a new marker of mucosal barrier function.

Beneficial effect of enteral glycine in intestinal ischemia/reperfusion injury

It has been shown in vitro that glycine can protect renal tubules and hepatocytes from hypoxic injury. Glycine also attenuates ischemic injury in transplanted livers. The present study investigated the effect of enteral glycine in a murine model of ischemia/reperfusion injury of the small intestine. Mice (n = 12 in each group) were randomized to receive two gastric gavages of either a 20% glycine (Gly) or 23% balanced amino acid (AA) solution with a 6-hour interval between each gavage. One hour after the second gavage, mice underwent superior mesenteric artery clamping for 20 minutes. The clamp was then released for reperfusion. Another group of mice (n = 8) underwent a sham operation and served as additional control animals. Six hours after ischemia/reperfusion, the mice were killed in order to assess the intestinal injury (intestinal protein content, mucosal disaccharidase activity, and intestinal histologic findings) and the systemic consequences (bacterial translocation, serum interleukin-6, and lung myeloperoxidase activity). A second set of mice (n = 55) underwent identical gavages and ischemia/reperfusion and they were followed for survival. Compared to AA, enteral glycine administered prior to intestinal ischemia/reperfusion injury significantly preserved mucosal indices and intestinal histology and decreased lung myeloperoxidase activity. Survival was also significantly increased in animals receiving glycine compared to AA control mice. These data suggest that enteral glycine supplementation may be beneficial in attenuating intestinal ischemia/reperfusion injury and its related systemic effects in this murine model.

Vibration-induced finger flexion reflex and inhibitory effect of acupuncture on this reflex in cervical spinal cord injury patients

The vibration-induced finger flexion reflex (VFR) and the inhibitory effect of acupuncture on this reflex were studied in five cervical spinal cord injury patients (C-SCIs). VFR, which is a tonic finger flexion reflex induced by vibratory stimulation on the finger tip, was induced before and after acupuncture was carried out on the same hand. A stainless steel needle was inserted to the Hoku point. As in healthy subjects, VFR was performed and it was significantly inhibited by acupuncture in the C-SCIs; mean maximum VFR was 204.2 +/- S.E. 68.6 g before and 119.8 +/- S.E. 42.2 g after acupuncture. The present results suggest that at least part of the reflex center for VFR is located in the spinal cord and that part of VFR inhibition by acupuncture may be mediated via the spinal cord.

Rheological analysis of peripheral blood neutrophils in a patient with cutaneous and arthropathic psoriasis accompanying hypopyon-iridocyclitis

A 32 year old Japanese male has had several synchronized attacks of psoriatic arthritis and hypopyon-iridocyclitis. During exacerbations, he has a leucocytosis with neutrophilia and elevated C-reactive protein. Assessment for adhesiveness, aggregation and deformation of peripheral neutrophils revealed strikingly high rheological activity whereas during periods of remission the activity was only slightly elevated above normal.

[Association of cytochrome P-450 1A1 (CYP1A1) gene polymorphism to smoking status and hematologic findings]

Measures to control smoking are important in the field of preventive medicine. In order to clarify differences in susceptibility in individuals to lung cancer of genotypes of CYP1A1, which are considered to be related to lung carcinogenesis were evaluated in 391 healthy males to study relationship to smoking status and hematological findings. No correlation was observed between genotypes of CYP1A1 and smoking status. White blood cell counts in smokers with a Val allele were significantly higher than in those without a Val allele. Multiple regression analysis showed that the genotype of CYP1A1 and daily cigarette consumption had significant relationship with white blood cell count in smokers. However, red blood cell count, hemoglobin, hematocrit, MCV, MCH, or MCHC were not significantly associated with genotype of CYP1A1. There have been no previous reports on the relationship between the genotype of CYP1A1 and hematological findings. In consideration of the epidemiologic findings that many individuals with increased white blood cell counts have cancer or cardiac diseases, and reports that the increase in the white blood count was associated with poor respiratory function, white blood cell count may be candidate to for being a risk marker and thus contribute to prevention of these diseases.

A total parenteral nutrition solution supplemented with a nucleoside and nucleotide mixture sustains intestinal integrity, but does not stimulate intestinal function after massive bowel resection in rats

The effects of supplementing a total parenteral nutrition solution with a nucleoside and nucleotide mixture on mucosal adaptive processes after massive bowel resection were studied. Male Wistar rats (n=30) underwent 80% small intestine resection, were randomized into two groups and received either standard total parenteral nutrition (TPN) or TPN supplemented with a nucleoside and nucleotide mixture (2.5 mL.kg-1.d-1). An additional five rats, fed a nonpurified diet and not resected, were used as controls. After 4 or 7 d, rats were killed and samples were collected for mucosal indices and intestinal enzymatic activities (disaccharidases and diamine oxidase). After massive small bowel resection and TPN, residual jejunal mucosal wet weights, villus heights, protein and RNA contents on d 4 and 7, and total wet weights and DNA contents on d 7 were significantly lower than in the control group. Administration of the nucleoside and nucleotide mixture resulted in significantly higher residual jejunal total and mucosal weights, proteins, DNA, RNA contents, and the ratio of proliferating cell nuclear antigen positive cells per crypt than did the standard TPN solution on d 7. However, disaccharidase and diamine oxidase activities were not affected by supplementation with the nucleoside and nucleotide mixture. Our data suggest the supplementation of a nucleoside and nucleotide mixture to a TPN solution can attenuate the initial mucosal atrophy and improve intestinal cell turnover after massive bowel resection, but the supplementation has little effect on enterocyte enzymatic activities.

Psoriatic arthritis and hypopyon-iridocyclitis. Possible mechanism of the association of psoriasis and anterior uveitis

BACKGROUND

We present a 32-year-old Japanese man with psoriatic arthritis who developed recurrent episodes of hypopyon-iridocyclitis associated with exacerbations of the arthropathy.

OBJECTIVE

To evaluate the mechanism of the association between psoriasis and uveitis, we analyzed the rheological characteristics of the patient's peripheral blood neutrophils during attacks and during remissions.

METHODS

The rheological activity of neutrophils was determined by the micropore filtration method. It was expressed as micropore filtration time when a neutrophil-erythrocyte suspension passes through a micropore filter (pore size 5 microns).

RESULTS

The micropore filtration time in this patient was longer than that of healthy control subjects (p < 0.01) and of psoriatic patients without uveitis (p < 0.05); it was also longer during the appearance of the eye disorder with the exacerbation of psoriatic arthritis than during remissions.

CONCLUSIONS

Activated neutrophils in the peripheral blood of our patient were probably responsible for the attacks of hypopyon-iridocyclitis as well as the exacerbation of psoriatic skin lesions and/or arthritis.

Modulation of thermogenic response to parenteral amino acid infusion in surgical stress

Thermogenic response to parenteral infusion of amino acid mixtures in rats undergoing surgical stress was investigated with the aid of a small animal indirect calorimeter. Male Wistar rats (n = 12) were laparotomized and received intestinal abrasion along with construction of a parenteral route. After 48 h, nutrient-induced thermogenesis (NIT) produced by amino acid mixtures was examined and compared with that of control rats (n = 12) without surgical stress. The NIT values of the leucine-enriched solution were greater than those of the control solution in both rats with and without surgical stress. The NIT generated by the leucine-enriched solution in rats with surgical stress was significantly higher than that in rats without. NIT values for 10 different kinds of single amino acid solutions with identical concentrations was then examined in 60 rats. The NIT values of the leucine and the glycine solutions were relatively higher than those of other solutions. However, when puromycin was injected intraperitoneally into 12 rats just before measurement of the NIT in response to amino acid mixtures, no significant differences were found in NIT values between the mixtures. In summary, surgical stress increased the thermogenic response to the leucine-enriched solution, indicating that utilization of leucine may be augmented under surgical stress. In fact, leucine itself may be a thermogenic amino acid. Inhibition of protein synthesis prevented the increase in thermogenic response induced by the leucine-enriched solution. We conclude that thermogenic responses to parenteral amino acid mixtures may differ depending not only upon the compositions of amino acids but also upon the host conditions.

Blocking adhesion of cancer cells to endothelial cell types by S. agalactiae type-specific polysaccharides

By using immortalized and normal endothelial cells, we were able to detect inhibitory effects of type specific polysaccharides from Streptococcus agalactiae on adhesion of cancer cells to endothelial cells, which is an essential step of cancer metastatis. The inhibition was probably due to specific structures of the bacterial polysaccharides, since the structures of the saccharides are very similar to those of cancer specific sialyl Lewis carbohydrates (sialyl Le(a) and Le(x)) which bind to ELAM-1 of endothelial cells. This result indicated that the bacterial polysaccharides from S. agalactiae could be very useful and hopeful as cancer metastasis inhibitors.

Leukopenia and rheological anomalies in leukocytes during hemodialysis in patients with chronic renal failure

In order to clarify the relation between leukopenia during hemodialysis and leukocyte adhesiveness, the number of circulating leukocytes, their filterability through 5 micron diameter pores, and the concentration of neutrophil elastase in plasma were measured in peripheral blood collected at the beginning of hemodialysis (dialyzer, cuprophane membrane), 15 min into dialysis, and end of dialysis (duration of dialysis, 180 min) in 15 patients with chronic renal failure. Leukopenia was most marked at 15 min in all patients. In accordance with the change in number of circulating leukocytes, the filtration time of the leukocytes, as determined by a modification of the Nuclepore filtration method (filtered blood volume 0.5 ml, leukocyte count 2,500 microliters, suction pressure 10 cm H2O temperature 37 degrees C) was significantly longer at 15 min versus the beginning and end of the dialysis (p < 0.005 and p < 0.025, respectively). Addition of the chemotactic peptide, N-formyl-methionyl-leucyl-phenylalanine (FMLP; 20 nM), to the suspensions immediately increased the leukocyte filtration time. Such FMLP-induced increases were significantly greater at 15 min versus the beginning of dialysis (p < 0.05). This heightened sensitivity of cells to FMLP appeared to persist until the end of dialysis (p < 0.05 versus the beginning). Plasma levels of neutrophil elastase were highest at the end of dialysis versus those at the beginning and after 15 min (both p < 0.005). Results suggest that the changes in filterability of leukocytes may be related to decreases in their number in the circulation. Neutrophil elastase appeared to accumulate in plasma so that its maximal value at the end of dialysis would reflect the preceding changes in leukocyte rheology.

[Effect of vitamin D receptor gene polymorphism and lifestyle on bone mineral density and bone mineral density decrement rate]

The effects of genetic and environmental factors on bone mineral density (BMD) were investigated in 108 healthy Japanese women. Of the 108 subjects, BMD (from the second to forth lumbar vertebrae) was measured in 1992 in 103, in 1993 in 100, and in both years in 95 by dual energy X-ray absorptiometry. Vitamin D receptor (VDR) gene polymorphism in intron 8 was used as a genetic marker. Information on menstruation, health status, lifestyle, quantities of nutrient intake and frequencies of food intake was obtained by questionnaire. The frequency of allele B (825bp), whose polymerase chain reaction (PCR) products cannot be cut with BsmI, was 0.259 and the frequency of allele b (650bp), whose PCR products can be cut with BsmI, was 0.741. The subjects in our study obeyed the Hardy-Weinberg law. While the frequency of allele B was 0.448 in European whites as reported by Morrison et al, it was 0.259 in our Japanese subjects, suggesting a racial difference. Z score values (average value 0, standard deviation 1) increased in the order BB, Bb and bb. This result indicates that allele B is associated with the lower BMD in Japanese, as in European whites. The BMD decrement rate increased in the order bb, Bb and BB, indicating that VDR gene polymorphism may be a regulatory factor for losing BMD. Most of lifestyle variables, calcium intake and vitamin D intake were not correlated with BMD, but the food frequency score (which was defined as values weighted in each of three food categories obtained by factor analysis) was significantly correlated with BMD. Multiple regression analysis showed significant influences of years after menopause, the food frequency score and VDR genotype on BMD. VDR genotype and years after menopause influenced the BMD decrement rate significantly in multiple regression analysis. Neither a relationship between BMD and calcium intake nor between BMD and vitamin D intake by VDR genotype was found. These results suggest that the VDR gene is a genetic factor in BMD and the BMD decrement rate in Japanese.

Late onset systemic lupus erythematosus diagnosed in an elderly man with unusual skin eruptions and sudden death

A rare case of late onset SLE in an elderly man presented with generalized toxicoderma-like eruptions. The rash first appeared at age 64 years and was characterized by dark or purplish erythematous eruptions disseminated over the body surface. Histological examination revealed marked liquefaction degeneration and leukocytoclastic vasculitis. Direct immunofluorescence study and serological examination results were suggestive of SLE; however, the patient had no episodes of photosensitivity, malar erythema, or arthralgia. He was diagnosed as having SLE 11 months after his first visit and died suddenly 16 months after onset. Elderly men with SLE can present with unusual clinical manifestations; careful examination of these patients is required to reach a correct diagnosis.

Interleukin-6 induces proteolysis by activating intracellular proteases (cathepsins B and L, proteasome) in C2C12 myotubes

1. A cell culture system of C2C12 myotubes was established as a model of the muscle. With the aid of this model, the half-lives of intracellular proteins as well as the activities and mRNA levels of proteasomes (26S and 20S) and cathepsins (B, L, and H) were examined in the presence of various amounts of cytokines. 2. It was found that 100 units/ml recombinant human interleukin-6 somewhat shortened the half-life of long-lived proteins to 23.79 +/- 1.55 h (control: 25.60 +/- 1.87 h). When 1% fetal bovine serum contained in the culture medium was replaced by 0.5 mg/ml bovine serum albumin, interleukin-6 was more effective since 10 units/ml of interleukin-6 shortened the half-life to 19.09 +/- 2.87 h (control: 22.26 +/- 321 h). Interleukin-6 (100 units/ml) increased the activity of 26S proteasome by 31.5%, of cathepsin B by 53.5% and of cathepsin B+L by 21.3%. These increases occurred in association with an increase in their transcription. 3. On the other hand, 1000 units/ml of recombinant human tumour necrosis factor alpha prolonged the half-life of long-lived proteins while reducing the protease activities of 20S proteasome (-27.1%), cathepsins B (-64.6%) and B+L (-54.9%). 4. These results suggest that interleukin-6 induces degradation of long-lived intracellular proteins by activating both the non-lysosomal (proteasomes) and lysosomal (cathepsins) proteolytic pathways. It is therefore concluded that interleukin-6 is a candidate for a proteolysis-inducing factor in myotubes and may play an important role in the progression of muscle degradation in systemic inflammatory responses induced by sepsis or severe injury.

In vivo assessment of striatal dopamine release in the aged male Fischer 344 rat

A microdialysis probe was implanted into the striatum of young (4- to 5-month-old) and aged (26- to 27-month-old) Fischer 344 male rats to assess age-related alterations in striatal dopamine (DA) release. Basal levels of DA and the magnitude of DA response evoked by 50 mM and 100 mM high potassium (K+) in aged rats were similar to those in young rats. Furthermore, K(+)-evoked DA release did not correlate with motor performance within either age group. In contrast, amphetamine (250 microM) evoked-DA release of aged rats was significantly lower than that of young rats. Moreover, the enhancement of K(+)-evoked DA release by oxotremorine (500 microM) was significantly attenuated in aged rats. These results indicate that a putative DA release mechanism and its cholinergic modulation of the aged striatum are impaired.

A boy with atrophic thyroiditis of prepubertal onset, who was positive for TSH-binding inhibitor immunoglobulins

A 12 year old boy was admitted to our hospital because of short stature. From the age of 7, his growth velocity decreased and he manifested intolerance to low temperatures, hoarseness, dry skin, and slowness of thought and physical movement. On admission, his height was 129.8 cm (-3 s.d.) and his body weight was 43.2 kg (-0.5 s.d.). His clinical features also included relaxation phase of tendon reflexes, periorbital puffiness and cold skin but no struma. His bone age was 9 years. His serum thyroxine (T4), triiodothyronine (T3), free T4 and free T3 were low, while his thyrotropin was high. He was positive for antithyroglobulin antibodies, antimicrosomal antibodies, and TSH-binding inhibitor immunoglobulins. He was diagnosed as having atrophic thyroiditis. We also determined the HLA haplotypes of his family members. His father's HLA haplotypes were A2, BW61(a) and A24, BW52(b), while his mother's haplotypes were A24, BW52(c) and A30, BW60(d). The HLA haplotypes of both the patient and his younger brother showed a and d, while the patient's elder brother's HLA haplotypes showed b and c. His family members all had normal thyroid function, but his father was positive for antimicrosomal antibodies. In summary, we describe a rare case where the onset of hypothyroidism was prepubertal, where the pathogenesis may have involved TSH-receptor blocking antibodies, and where the inheritance of the disease may have been from the paternal side of the family.

[Reliability and validity of a Japanese version of the cost of care index]

The home management of chronic disability in the elderly often relies upon the receipt of family. These caregivers have been shown to experience a considerable burden in providing day-to-day care. It is important that identifying problem areas may result in the need of consider alternatives for the care of an elderly person, identify and mobilize existing community resources to relieve some of the "cost". We studied the reliability and validity of a Japanese version of the Cost of Care Index (CCI) which was originally developed by Kosberg et al as a case management tool in the assessment of caregivers. Our subject consisted of 27 cases with dementia (mean age 74.5 years), and 15 cases of patients with neurological disorders without dementia (80.7 years), and their caregivers. The test-retest reliability and internal consistency were very good; the coefficient of correlation between CCI scores at the two interviews was 0.83, the coefficient of internal consistency was 0.92. CCI scores correlated significantly with ADL-20 scores, DBD score and caregivers' SDS scores; r = -0.48, r = 0.46 and r = 0.36, respectively. Our results indicate that the CCI is highly reliable, and may be useful for assessment caregivers' burden.

Interrelation of intracellular proteases with total parenteral nutrition-induced gut mucosal atrophy and increase of mucosal macromolecular transmission in rats

Total parenteral nutrition (TPN) is known to induce mucosal atrophy and to increase macromolecular transmission of the small intestine. The potential participation of various proteases in that process was investigated. Male Wistar rats were randomly divided into two groups: the TPN group (n = 11) received a standard TPN (250 kcal/kg per day, 1.78 g nitrogen/kg per day) and the FED group (n = 10) received a standard rat food for 1 week. This was followed by an examination of gut macromolecular transmission of fluorescein isothiocyanate dextran 70,000 (FITC-dextran) after intragastric injection and of the activities of gut mucosal cathepsins B, H, and L and of proteasome. Mucosal wet weight and protein content decreased significantly by TPN for 1 week. In both groups, the activities of all proteases in the ileum were significantly greater than in the jejunum. In the TPN group, cathepsin L and H activities in the ileum, and cathepsin B activity in both the jejunum and the ileum, were greater than those in the FED group. The portal concentration of FITC-dextran was higher than arterial and venous concentrations in the both groups. In the TPN group, the portal FITC-dextran concentration increased significantly compared with the FED group. In conclusion, active proteolysis is not associated with TPN-induced mucosal atrophy. Cathepsins activities in the ileum increase as a result of TPN. Interrelationship is implicated between increase of lysosomal protease activity and the deterioration of the intestinal barrier function, which permits macromolecular transmission.

Isolation of immortal human endothelial cells

To get immortalized endothelial cells, human endothelial cells were transfected with a temperature-sensitive simian virus 40 DNA. The majority of transfected cells showed a prolonged life span and temperature-dependent cell growth. One of the clones, #5-1, grew either at 33 or 37 degrees C and could be cultured more than 110 generations. The cells expressed several endothelial cell specific characteristics.

Antibody-conjugated magnetoliposomes for targeting cancer cells and their application in hyperthermia

Magnetoliposomes for hyperthermia treatment of cancer were prepared by coating phospholipid on to magnetite particles. The optimum phospholipid composition for dispersibility was a phosphatidylcholine/phosphatidylethanolamine ratio of 2:1. The average size of the magnetoliposomes, which were aggregates of 10 nm core magnetite particles, was about 80 nm. The magnetoliposomes were coated with hydrazide pullulan to stabilize the phospholipid capsules and provide an anchor for the immobilization of antibodies. By this method, 90-180 molecules of a monoclonal antibody were immobilized on to a magnetoliposome particle. When the antibody-conjugated magnetoliposomes were incubated with cancer cells, they were adsorbed on to the cell surface and incorporated by the cells about 12 times more effectively than the control after 4 h. The amount of incorporated magnetite was 0.61-3.6 pg/cell, depending on the antigen-antibody system. The heating properties of the magnetoliposomes were also measured and found to vary with the size of the core magnetite.

[Effects of pepsinogen C gene polymorphisms on serum pepsinogen I and serum pepsinogen II levels]

Recently pepsinogens have been considered to be effective markers of terminal differentiation of stomach mucosa, and also good markers of preneoplastic and neoplastic changes of the stomach mucosa. Not a few studies concerning polymorphisms of pepsinogen A and C genes have been reported, however, as far as the authors are aware, no study was performed as to the relation between polymorphisms and serum pepsinogen I and II levels. Polymorphisms of the pepsinogen C (PGC) gene were identified by PCR, which amplifies DNA in the region within the intron between exon 7 and exon 8, and 6% polyacrylamide gel (no urea) electrophoresis. Six alleles were observed in the Japanese population. Frequencies for these alleles in 221 unrelated Japanese individuals were 0.077, 0.036, 0.328, 0.240, 0.009 and 0.310, respectively. The association between the PGC genotype and serum pepsinogen was investigated. A higher serum pepsinogen II level was observed in individuals homozygous for allele 6 than in those with other genotypes. This result indicates that careful attention should be paid to the genetic background of serum pepsinogen in screening of stomach cancer by this method.

Unsei-in inhibits rheological activity of leukocytes: mechanism of action in neutrophil-related skin diseases

To investigate the efficacy of Unsei-in on skin diseases such as Behçet's disease, palmoplantar pustulosis and psoriasis vulgaris, the rheological activity of leukocytes as manifested by adhesiveness, deformability and aggregability was studied in vitro using a micropore filtration method. Unsei-in inhibited the rheological activity of leukocytes at a statistical significance of p < 0.01 in normal individuals whose leukocytes had been stimulated with N-formyl-methionyl-leucyl-phenylalanine (FMLP). It did not, however, inhibit the activity of cells that had not been stimulated by FMLP. In contrast, in Behçet's disease, Unsei-in inhibited rheological activity of non-stimulated leukocytes (p < 0.01) but did not inhibit the rheological activity of FMLP-stimulated leukocytes. In a study using Ouren-gedoku-to and Shimotsu-to, the main constituents of Unsei-in, the latter inhibited the activity of FMLP-stimulated leukocytes in normal individuals (p < 0.02). These results indicate that Unsei-in has an inhibitory effect on rheologically-activated neutrophils, which are involved in the healing mechanisms of the above skin diseases, and it also has a satisfactory effect in the form of a mixture of Shimotsu-to and Ouren-gedoku-to.

Concurrent chemotherapy (5-fluorouracil and cisplatin) and radiation therapy for inoperable squamous cell carcinoma of the esophagus potentially followed by surgery

Twenty-four previously untreated patients with primary inoperable squamous cell carcinoma of the esophagus showing no evidence of hematogenous metastasis were treated with concurrent chemotherapy and radiation therapy (CRT) followed by surgical resection if possible. The chemotherapy regimen consisted of 5-fluorouracil 750 mg/m2 on days 1-4 and 21-24, and cisplatin 70 mg/m2 on days 1 and 21. Radiation therapy was administered over days 1-26 (200 cGy/day five times per week with an initial planned dose of 40 Gy). Five patients (8%) showed complete response (CR), 14 patients (58%) had partial response (PR), and 19 had good local control (CR 2, PR 17). Eleven cases (48%) underwent esophageal resection with no operative mortality. Curative resection was accomplished in eight cases (35%). Toxicities observed in CRT were leukopenia (grades 3 and 4) 38%, nausea and vomiting (grades 2 and 3) 67%, esophagitis 42%, and fever 42%. The median survival time (MST) for 11 neoadjuvant cases was 349 days (P < 0.05) compared to 212 days for palliative treatment (six cases) and 126 days for no treatment (six cases) after CRT. The MST of eight patients who received curative resection had not been reached after a 17-month median follow-up time. Concurrent chemotherapy with 5-fluorouracil plus cisplatin and radiation proved to be a safe regimen yielding a satisfactory response and minimal toxicity in this particular group of patients. Extensive surgery was thus determined to be feasible after CRT and to contribute to prolonging survival.

Effect of acupuncture at the Hoku point on vibration-induced finger flexion reflex in man: comparison between press needle technique, electroacupuncture, and in-situ technique

Effects of press needle technique (PN), electroacupuncture (EA), or in-situ technique (IS) on vibration-induced finger flexion reflex (VFR) were examined in 31 healthy adults. VFR, which is tonic finger flexion evoked by vibration applied to the finger tip, was induced by vibrating the volar side of the middle finger tip before and after acupuncture. Acupuncture was applied to the Hoku point on both sides. The three techniques, each studied on separate days, inhibited VFR and there was no significant difference in VFR inhibition among the three techniques (percentage of pre-acupuncture VFR was 71.5 +/- SE 2.2% after PN, 72.6 +/- SE 2.4% after EA, and 75.6 +/- SE 2.8% after IS). The results suggest that afferent signals from muscles contracting due to electrical stimulation had no significant effect on the reflex arcs of VFR; and that the intradermal stimulation by acupuncture played a significant role in VFR inhibition.

[Study on the association between risk factors for osteoporosis and bone mineral density]

The relationship between bone mineral density (BMD) and risk factors for osteoporosis was investigated on 146 females (23-68 years old) in Enzan city, Yamanashi prefecture. BMD was measured by DEXA (Dual Energy X-ray Absorptiometry) method. Information regarding menstruation, health status, life-style, quantities of nutrient intake and frequencies of food intake were obtained by questionnaire. Fitness level was determined by exercise test and daily energy expenditure by calorie-counter. The results were as follows; 1) No relationship between physical activities or daily energy consumption and BMD was found. 2) No relationship between calcium intake or vitamin D intake and BMD was found, but a significant and positive correlation coefficient between intake frequency of milk products and BMD was observed. 3) Significant influences of age, BMI, presence of lumbago and food frequency score on BMD were indicated by multiple regression analysis. Food frequency score were defined as values weighted in each of three food category, obtained by factor analysis. 4) Significant influences of height decrement rate per year and number of years postmenopausal on BMD reduction rate per year were indicated by multiple regression analysis. These results suggest that these significant factors are useful in indications of risk for osteoporosis.

Development of a thermoelectric cooling apparatus for high-voltage isoelectric focusing on a cellulose acetate membrane

To develop an isoelectric focusing apparatus using a cellulose acetate membrane (Separax EF), we have designed a thermoelectric cooling isoelectric apparatus. This apparatus has two characteristics. Firstly, the cooling system was switched to a thermoelectric cooling system from an ice-cooling system. Secondly, the chamber lid of the electrophoretic apparatus was also devised so that samples could be applied without opening the chamber lid. With this apparatus we could perform the isoelectric focusing without worrying about room temperature and humidity in the laboratory. Applying 2000 V for an extra 5 min with our module cooling system, we achieved a much higher degree of resolution with three sheets of cellulose acetate membrane (Separax EF) overlaid for simultaneous electrophoresis. Thus, three types of information could be obtained from only one electrophoretic procedure.

Molecular properties, substrate specificity and regulation of DNA-dependent protein kinase from Raji Burkitt's lymphoma cells

A double-stranded DNA-dependent protein serine/threonine kinase (DNA-PK) was purified from a nuclear extract of Raji Burkitt's lymphoma cells by a three-step column-chromatographic procedure. The main silver-stained band visualized after SDS/PAGE corresponded to an autophosphorylated polypeptide of about 350-kDa that represents the catalytic component. The existence of Ku DNA-binding protein as a regulatory component in the purified enzyme was revealed by Western blot/enzyme immunoassay and direct inhibition test with anti-Ku sera from the autoimmune patients. The DNA-PK catalyzed phosphorylation of synthetic peptides corresponding to Myc and RB proteins in a DNA-dependent manner, indicating that DNA-PK may recognize a second core-sequence motif Pro-Ser/Thr- in addition to the putative consensus sequences of -Ser/Thr-Gln. The level of enzyme activity was significantly higher in DMSO-induced G0/G1-arrested Raji cells as well as in the cells after release from DMSO than in the log-phase cells.