A novel donor splice site mutation in the glycogen debranching enzyme gene is associated with glycogen storage disease type III

Analysis of glycogen debranching enzyme (debrancher) cDNA from a patient with glycogen storage disease type III revealed a deletion of 124 base pairs. A donor splice site mutation (IVS G+1 to T) was identified in the patient's debrancher gene, which caused exon skipping of the upstream exon and resulted in a truncated enzyme due to premature termination. Mutational analysis of the patient's family showed that this point mutation was inherited from the father. Southern blot analysis of the patient's genomic DNA showed an additional, unique EcoRI fragment of 5.8 kb, which was inherited from the mother. These results suggested that the patient was a compound heterozygote for the donor splice site mutation, which is the first identified in the debrancher gene, and had a genetic defect relating to an aberrant 5.8-kb EcoRI fragment.

Dose-dependent effect of niceritrol on plasma lipoprotein-a

Lipoprotein-a, Lp(a), is a variant form of low density lipoprotein (LDL) that contains apolipoprotein-a, whose structure has 75-85% homology with plasminogen. Elevated plasma levels of Lp(a) are considered to be one of the independent risk factors for cardiovascular disease. We studied the effects of niceritrol, a nicotinic acid derivative, on plasma Lp(a) levels in 72 patients with hypercholesterolaemia. The dose of niceritrol was increased every 4 weeks, from 750 to 1500 and then to 2250 mg day-1. The final dose was adjusted to obtain a plasma cholesterol level less than 5.69 mmol l-1. Niceritrol led to significant decreases in plasma levels of median Lp(a), from 16.1 mg dl-1 (interquartile intervals, 8.7 to 32.8) to 11.1 mg dl-1 (interquartile intervals, 6.6 to 21), the mean reduction rate being 17.6%. In the group with pretreatment Lp(a) levels of over 20 mg dl-1, Lp(a) decreased by 10.0, 22.0 and 31.8% at the doses of 750, 1500, and 2250 mg day-1, respectively. In the group with levels less than 20 mg dl-1, only the dose of 2250 mg day-1 was effective in the reduction of Lp(a). The results suggest that the reduction of Lp(a) was dependent on the dose of niceritrol and on the pretreatment level of Lp(a). In conclusion, niceritrol is effective, in a dose-dependent manner, for reducing Lp(a) levels.

Hypertriglyceridemia and low HDL cholesterol in Japanese patients with NIDDM

Diabetes is frequently associated with the combination of hypertriglyceridemia and low HDL cholesterol level, a known risk factor for cardiovascular disease. We evaluated the frequency of elevated serum triglyceride and the reduced HDL cholesterol levels in Japanese male NIDDM patients. Hypertriglyceridemia (>1.69 mmol/l) and low HDL cholesterol level (<0.91 mmol/l) were frequently found in Japanese male (NIDDM patients (30.4 and 14.2%, respectively). The combined abnormality, i.e., hypertriglyceridemia with concomitant low HDL cholesterol level, was more common in patients with poor glycemic control. We observed that inpatient diet therapy markedly reduced serum triglyceride but serum HDL cholesterol did not change significantly. This is in marked contrast to primary hypertriglyceridemia, in which HDL cholesterol level generally increases in parallel with a reduction in serum triglyceride level. We discuss the defective removal of triglyceride-rich lipoproteins and ineffective HDL production caused by lipoprotein lipase (LPL) deficiency. We also discuss possible correction of this combined abnormality by certain maneuvers that increase LPL activity.

Risk factor analyses for macrovascular complication in nonobese NIDDM patients. Multiclinical Study for Diabetic Macroangiopathy (MSDM)

To examine the characteristic features of risk factors for macroangiopathy (MA) in nonobese Japanese NIDDM patients, 899 NIDDM patients with and without MA were registered from 40 facilities. Of these, 386 subjects were identified as having any form of MA (total MA); these included 211 with ischemic heart disease (IHD), 163 with cerebrovascular disease (CVD), and 77 with peripheral vascular disease (PVD). Univariate analyses revealed the following common risk factors for total MA, IHD, CVD, and PVD: age, hypertension, systolic blood pressure (sBP) or diastolic blood pressure (dBP), duration of diabetes, diabetic microangiopathy (retinopathy, nephropathy, and neuropathy), low HDL cholesterol level, and higher LDL cholesterol/HDL cholesterol ratio. Additional significant risk factors for specific conditions were also identified, respectively, as male sex for total MA, IHD, and PVD, smoking for IHD and PVD, and high fasting plasma glucose level for total MA and CVD. With stepwise multivariate logistic regression analysis, older age, duration of diabetes, smoking, and low LDL cholesterol/HDL cholesterol ratio were identified as significant and independent risk factors for total MA, IHD, CVD, and PVD. Other risk factors identified were high dBP for IHD, CVD, and PVD, high sBP for total MA, and low BMI for PVD. These results clearly demonstrated that duration of diabetes, smoking, hypertension, and dyslipidemia are major risk factors for MA in NIDDM patients. Since the mean BMI was similar for both groups (approximately 23 kg/m2) and there were no significant differences in immunoreactive insulin levels before and after 75-g oral glucose challenge testing, obesity and hyperinsulinism at the time of the analyses were not considered to play an important role for the pathogenesis of MA in Japanese NIDDM patients. By using the chi 2 test, cutoff points were determined for six of the most commonly measured risk factors. The cutoff point was the level beyond which a significantly higher prevalence of MA occurred. The cutoff points (rounded slightly upward in some cases) for fasting plasma glucose, sBP, dBP, serum total cholesterol level, serum triglyceride level, and BMI were 140 mg/dl, 140 mmHg, 80 mmHg, 180 mg/dl, 120 mg/dl, and 23 kg/m2, respectively. When these cutoff points were used as control criteria, the prevalence of MA was significantly lower in subjects whose risk factor measurements remained under the proposed control criteria for four or more of the six variables. In conclusion, in nonobese NIDDM patients, age, hypertension, and dyslipidemia were found to be risk factors for MA. Duration of diabetes was also demonstrated as an independent risk factor, indicating the close association of deranged glucose metabolism with the pathogenesis of MA in NIDDM patients. It seems to be crucial to control these risk factors for the prevention of MA in NIDDM patients.

Chronological observation of mouse endometrial carcinogenesis induced by N-methyl-N-nitrosourea and 17 beta-estradiol

Chronological observation of the neoplastic endometrial lesions induced by N-methyl-N-nitrosourea (MNU) and 17 beta-estradiol (E2) were studied. E2 induced cystic glandular hyperplasia, but adenomatous hyperplasia was induced predominantly by MNU. Atypical hyperplasia and adenocarcinoma were induced cooperatively by E2 and MNU, and first found at week 12; the incidence of adenocarcinoma increased in accordance with the week-course. Some atypical hyperplasia might be changed to adenocarcinoma. Mean AgNORs numbers in (pre)neoplastic lesions increased in accordance with neoplastic changes. This model was useful for clarifying histogenesis of human endometrial carcinogenesis.

[Effect of preoperative oral 5-fluorouracil on cell cycle of advanced cervical squamous cell carcinoma]

Using flow cytometry, we examined the correlations between the tumor stage and the cell cycle in subjects with advanced cervical squamous cell carcinoma as well as between the changes of cell cycle caused by 5-FU and their prognoses. Before 5-FU treatment, 75.9 +/- 9.6% of the patients were at G1 phase, 16.8 +/- 3.9% at S and 7.3 +/- 4.5% at G2/M. The change of cell cycle was not accompanied by the progression of tumor stage. Sixteen patients received oral 5-FU (300 mg/day) for at least 2 weeks before operation. In the patients at stage I, the cell cycle was not changed even after 5-FU treatment. They have been cancer-free for 3 postoperative years. While early recurrence was found in 4 of 5 cases at stage II or III showing progression at G1, all 6 cases who had regressed or remained unchanged at G1 were free from recurrence (p = 0.0152). These results suggested that the cell cycle is not necessarily correlated with the progression of tumor stage in patients with this kind of carcinoma, and that the change of cell cycle due to preoperative oral 5-FU could be a predictive indicator for their prognoses. Especially for those with poor prognoses who had shown progression at G1, more potent adjuvant chemotherapy should be planned.

The mechanical properties of the heel pad in elderly adults

The shock absorbing characteristics of the heel pad in vivo were examined in two groups of active elderly individuals whose ages ranged between 60 and 67 years (n = 10) and between 71 and 86 years (n = 10). For comparative purposes, young adults (n = 10) aged between 17 and 30 years were also examined. A free-fall impact testing device which consisted of an instrumented shaft (mass 5 kg), accelerometer and position detection transducer was used to obtain deceleration and deformation of the heel during impact. The data were obtained from impact velocities of 0.57 m.s-1 (slow) and 0.94 m.s-1 (fast). Peak values of the deceleration and deformation, as well as the time to these peaks from onset of impact, and energy absorption were evaluated. At the slow impact velocity, no age effect was found for the parameters examined except for the energy absorption. At the fast impact velocity, there was higher peak deceleration and smaller deformation for the elderly than for the younger adults. The energy absorbed was less for the elderly than for the younger adults. It was concluded that the capacity for shock absorbency of the heel pad declines with age.

Adverse events associated with MMR vaccines in Japan

The largest nationwide active surveillance of four Measles-Mumps-Rubella (MMR) vaccines was conducted in Japan. A total of 1255 pediatricians actively participated in the study, which comprised 8.6% of all members of the Japanese Pediatric Society. The total number of registered recipients of MMR vaccines was 38 203. They were arbitrarily given one of the MMR vaccines produced by three makers (Takeda, Osaka city, Kitasato Minato-ku. Tokyo and Biken Suita city, Japan) or the standard MMR vaccine made of designated strains (Kitasato's measles-AIK-C, Biken's mumps-Urabe Am9 and Takeda's rubella-To336) produced by Takeda, Kitasato and Biken and were observed for 35 days. The rates of virologically confirmed aseptic meningitis per 10,000 recipients were 16.6, 11.6, 3.2 and 0 for the standard MMR, Takeda MMR, Kitasato MMR and Biken MMR vaccines, respectively. The incidence of convulsions between 15 and 35 days was the highest with the standard MMR vaccine and the incidence of fever associated with vomiting occurring between 15 and 35 days (symptoms relevant to aseptic meningitis) were also the highest with the standard MMR vaccine. The incidence of parotid swelling was the lowest with Takeda MMR vaccine. This surveillance revealed that incidences of aseptic meningitis after administration of the standard MMR vaccine and of Biken MMR vaccine were different. This posed questions about the manufacturing consistency of the Urabe Am9 mumps virus vaccines. On the other hand, the National Institute of Health found that the biological characteristics of the Urabe Am9 mumps virus contained in the standard MMR vaccine and in the Biken MMR vaccine were different. The Biken Company reported that the mumps vaccine in the standard MMR vaccine was a mixture of two Urabe Am9 mumps vaccine bulks; one identical to that contained in the Biken MMR vaccine and the other produced by a different manufacturing process.

Very low density lipoprotein receptor binds apolipoprotein E2/2 as well as apolipoprotein E3/3

The VLDL receptor, a newly identified lipoprotein receptor, recognizes apoE containing lipoproteins. The human VLDL receptor was overexpressed in 1d1A-7, a mutant Chinese hamster ovary cells lacking LDL receptors. Each VLDL obtained from a normolipidemic subject with two epsilon3 or epsilon2 alleles similarly competed for the binding of radiolabeled rabbit beta-VLDL to the VLDL receptors. The anti-apoE monoclonal antibody 1D7, which inhibited binding of apoE3 to the LDL receptors, failed to compete for the binding of VLDL (apoE3 or apoE2) to the VLDL receptors. Results indicate that the binding site of apoE on the VLDL receptor may differ from its binding site on the LDL receptor.

Small doses of subcutaneous insulin as a strategy for preventing slowly progressive beta-cell failure in islet cell antibody-positive patients with clinical features of NIDDM

We report a pilot study to determine the preventive effect of small doses of insulin injected subcutaneously on slowly progressive beta-cell damage in islet cell antibody (ICA)-positive patients with apparent NIDDM. Ten NIDDM patients who were ICA' were divided into two groups of five. In the insulin group (age: 51 +/- 8 years [mean +/- SD], sex: 3 men and 2 women), intermediate-type insulin (3-16 U/day) was given once or twice daily as a subcutaneous injection. The sulfonylurea (SU) group (age: 48 +/- 11 years, sex: 3 men and 2 women) was initially treated with a SU agent. Changes in beta-cell function, as indicated by serum C-peptide responses and blood glucose values during a 100-g oral glucose tolerance test, as well as ICA and GAD antibody status, were evaluated for up to 30 months in both groups. ICA status became negative in four of five patients in the insulin group. ICA status did not become negative in any of the patients in the SU group (P = 0.047 vs. insulin group). ICA status was persistently positive in two patients whose beta-cell function eventually progressed to an insulin-dependent state and fluctuated in the remaining three patients. In the insulin group, GAD antibody status became negative in one of four initially GAD antibody-positive NIDDM patients. In the SU group, GAD antibody status was persistently positive in three NIDDM patients (NS vs. insulin group). The serum C-peptide response improved significantly within 6 and 12 months in the insulin group, whereas it decreased progressively in the SU group. The changes in C-peptide response were significantly different between the two groups at 6, 12, 24, and 30 months. Two-hour blood glucose and HbA1 values were unchanged in the insulin group, but they increased in the SU group. Subcutaneous small doses of insulin, resulting in a high rate of negative conversion of ICA and an improved serum C-peptide response, may be effective in treating ICA+ NIDDM patients who are at high risk for slowly progressive beta-cell failure.

Centrally administered neuropeptide FF inhibits arginine vasopressin release in conscious rats

There is evidence indicating that neuropeptide FF (NPFF) is an endogenous modulator of opioid systems. In the present study, we investigated the effect of centrally administered NPFF on arginine vasopressin (AVP) release in conscious rats. The plasma AVP increase in response to either hyperosmolality [i.p. injection of hypertonic saline (600 mosmol/kg)] or hypovolemia [i.p. injection of polyethylene glycol (PEG)] was significantly blunted when NPFF was injected into the lateral ventricle so that the given drug could act at the hypothalamus and also reach the brain stem (hypertonic saline with 10 micrograms/rat NPFF, 3.28 +/- 0.48 pg/ml; hypertonic saline alone, 7.85 +/- 1.78 pg/ml; PEG with 10 micrograms/rat NPFF, 4.07 +/- 1.40 pg/ml; PEG alone, 8.25 +/- 1.90 pg/ml). The plasma AVP increase in response to PEG-induced hypovolemia was also attenuated significantly and more potently when NPFF was injected into the cisterna magna so that the given drug could be readily accessible to the dorsal medulla where the nucleus of solitary tract is located (10 micrograms/rat; 2.71 +/- 0.14 pg/ml). In contrast, the NPFF injected into the cisterna magna had no significant effect on hyperosmolality-induced AVP release. Treatment with naloxone (10 mg/kg BW, sc) significantly reversed the inhibitory effects of NPFF on AVP release. These results suggest that central NPFF might play an inhibitory role via the hypothalamus in the osmoregulation of plasma AVP and via both the hypothalamus and the nucleus of solitary tract in the baroregulation, and that the intrinsic opioid systems are involved in the action of NPFF.

Lipoprotein(a) is an independent risk factor for multiple cerebral infarctions

In an attempt to ascertain whether Lp(a) is a risk factor for multiple cerebral infarctions (MCI), we have studied 83 patients with proven MCI and 39 subjects without MCI by computed tomography (CT). Seventy-one patients with non-insulin-dependent diabetes mellitus (NIDDM) were included: 52 with and 19 without MCI. Serum Lp(a) levels were significantly higher in patients with MCI than in subjects without MCI. There were no differences in serum Lp(a) levels between NIDDM and non-diabetic patients with MCI. The logistic regression analysis revealed that Lp(a) and hypertension were independent risk factors for the cerebral event. The current study demonstrated that Lp(a) and hypertension are significant risk factors for multiple cerebral infarctions.

Oxidative damage and enhanced erythrophagocytosis in canine erythrocytes infected with Babesia gibsoni

Oxidative damage to canine erythrocytes infected with Babesia gibsoni was investigated. B. gibsoni was cultured together with erythrocytes from normal dogs. When parasitemia reached a peak level, concentrations of both methemoglobin (metHb) and malondialdehyde (MDA), an end product of lipid peroxidation, in erythrocytes were significantly higher than at cultivation Day 0. In addition, B. gibsoni-infected dogs with high parasitemia showed significant increases of both metHb and MDA concentration in erythrocytes compared to those in uninfected dogs. Furthermore, erythrocytes from parasitized culture were more susceptible to phagocytosis by bone marrow macrophages from normal dogs than erythrocytes from the control culture. In addition, macrophages ingested not only parasitized erythrocytes but also non-parasitized cells. These results suggested that oxidative damage to erythrocytes was induced by the multiplications of B. gibsoni, and that non-parasitized erythrocytes were also exposed erythrocytes oxidative stress during the infection by B. gibsoni.

Discrimination of grip force for preschool children aged 5 to 6 years

The ability to discriminate grip force was investigated in 30 preschool children aged 5 to 6 years in an experiment controlling for motivation and muscle fatigue. The subjects were required to maintain a relatively high force during the discrimination with forces of the standard stimulus being 1.0, 2.0, and 3.0 kgf. Comparison stimuli changed at an interval of 0.1 kgf. Discrimination was measured in terms of the lower threshold, upper threshold, and interval of uncertainty. Since the statistical analyses indicated that there were no significant gender differences, data for boys and girls were combined. Although the upper and lower thresholds and the interval of uncertainty increased with the force required by the standard stimuli, Weber fractions did not remain constant when the stimulus intensity changed, unlike the findings in previous studies for adults.

Neuropeptide FF reduces food intake in rats

The effect of neuropeptide FF (NPFF), a mammalian FMRFamide-like peptide with antiopioid activity, on food intake was investigated in food-deprived rat. The ICV administration of NPFF (5 or 10 micrograms/rat) reduced food intake during the first 60 min after administration. ICV injection of naloxone (10 or 100 micrograms/rat), an opioid antagonist, also decreased food intake. However, the combination of NPFF and naloxone showed no additivity in the anorexigenic effect, suggesting that NPFF and naloxone reduced food intake by the common mechanism. These results indicate that NPFF may function as an endogenous anorexigenic peptide with anitiopioid function.

Successful pregnancy in a patient with pseudomyxoma peritonei arising from ovarian mucinous cystadenocarcinoma treated with cisplatin

A 24-year-old Japanese woman clinically showing pseudomyxoma peritonei arising from ovarian mucinous cystadenocarcinoma FIGO stage Ic is reported. She received intra-abdominal administrations of cisplatin five times following left oophorectomy. After being free of disease for 6 months, she conceived and carried two pregnancies to successful deliveries at 34 and 37 weeks, respectively. At the Cesarean sections, there were no abnormal findings except for right ovarian mucinous cystadenoma. She has had no evidence of recurrence by the time of the 60-month postoperative examination.

Overexpressions of c-fos/jun mRNA and their oncoproteins (Fos/Jun) in the mouse uterus treated with three natural estrogens

To further understand hormonal carcinogenesis of natural estrogens (estrone, 17 beta-estradiol (E2) and estriol), we determined the expressions of c-fos/jun mRNA, and their oncoproteins (Fos/Jun) with intracellular localization in the uterus of ovarectomized mice treated with these estrogens. Mid-term chronic, as well as short-term assays were examined. Of three estrogens examined, mid-term chronic E2-treatment significantly increased the expression of c-fos/jun mRNA, and their oncoproteins (Fos/Jun). These were most prominently expressed in glandular cells of E2-treated mouse endometrium. Therefore, mid-term chronic E2-treatment might partially induce glandular cell transformation of uterine endometrium via overexpression of Fos/Jun.

Residual beta-cell function and HLA-A24 in IDDM. Markers of glycemic control and subsequent development of diabetic retinopathy

To identify risk factors for diabetic retinopathy in insulin-dependent diabetes mellitus (IDDM), we studied the relationships among residual beta-cell function, human leukocyte antigen (HLA), long-term glycemic control, and development of diabetic retinopathy in 128 IDDM patients. Residual beta-cell function was assessed by serum C-peptide immunoreactivity (CPR) response to a 100-g oral glucose load (delta CPR). The patients were stratified into three groups: those with delta CPR of < 0.033 nmol/l (group 1, n = 50), those with delta CPR of 0.033-0.1 nmol/l (group 2, n = 38), and those with delta CPR of > 0.1 nmol/l (group 3, n = 40). The cumulative incidence rate of background retinopathy was higher in the order of groups 1, 2, and 3 (P = 0.032). Group 1 progressed to preproliferative retinopathy at an earlier stage than did groups 2 and 3 combined (P = 0.028). Further progression to proliferative retinopathy tended to be earlier in group 1 than in groups 2 and 3 combined (P = 0.083). The mean HbA1c value rose from 9.01 +/- 1.06% (mean +/- SD) in group 3 to 9.75 +/- 0.79% in group 2 to 10.48 +/- 1.12% in group 1 (P < 0.0001). In group 1, 89.6% of the patients had HLA-A24, whereas 50 and 43.6% of the patients had this antigen in groups 2 and 3 respectively (P < 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)

Evaluation of a low-dose intravesical bacillus Calmette-Guérin (Tokyo strain) therapy for superficial bladder cancer

To examine whether intravesical instillation of low-dose bacillus Calmette-Guérin (BCG) therapy is effective with low toxicity, we reviewed data for 111 patients with superficial bladder cancer (stages Ta and T1). Among them, 74 received the BCG treatment for prophylaxis of intravesical recurrence after transurethral resection, and the remaining 37 therapeutically for Ta or T1 tumours. The patients were divided into two groups by instillation dose of BCG (Tokyo 172 strain): 40 mg (n = 55) and 80 mg (n = 56), and statistically compared for recurrence, antitumour effect and toxicity. The mean instillations were done 8.4 times in the 40 mg dose group and 8.6 times in the 80 mg dose group. Among the 74 patients with BCG therapy for prophylaxis those with a previous episode of bladder cancer treatment (n = 47) experienced a significantly (p = 0.006) shorter recurrence-free interval than those with no episode (n = 27). Among 47 patients with a previous treatment episode, those receiving the 80 mg dose demonstrated a significantly longer recurrence-free interval than those given the 40 mg dose (p = 0.03). Among the 27 patients without previous treatment no significant difference in recurrence-free intervals was found between the two dose groups. Univariate and multivariate analyses using Cox's proportional hazards model confirmed the above findings. The recurrence index was also significantly reduced after BCG therapy in the 80 mg and 40 mg groups and similar antitumour effects for Ta or T1 tumours were observed in the two dose groups. The degree of toxicity due to BCG therapy was significantly (p = 0.02) lower with the 40 mg dose. The present study suggests that (1) a 40 mg BCG low-dose (Tokyo 172 strain) regimen is useful for preventing recurrence, with sufficient therapeutic efficacy and low frequency of toxicity, among patients without a previous treatment, and (2) prophylactic effects with the 80 mg dose regimen are much superior for previous treatment cases.

Evaluation of DNA fingerprinting by PFGE as an epidemiologic tool for Salmonella infections

To evaluate DNA fingerprinting as an epidemiologic tool, pulsed-field gel electrophoresis (PFGE) was performed on isolates of Salmonella, including S. typhimurium, S. thompson, and S. enteritidis. Chromosomal DNA was digested with the restriction endonucleases Bln I and Xba I. The patterns of S. thompson and S. typhimurium isolates from various sources were different from one another. There was no correlation between the phage type and the digestion pattern of S. enteritidis isolates. Some strains belonging to one phage type were distinguished by their PFGE pattern in this study. These results suggest that the Bln I and Xba I digestion patterns of chromosomal DNA are useful for epidemiological analysis of an outbreak of Salmonella infection or food poisoning.

Inhibitory effects of medroxyprogesterone acetate on mouse endometrial carcinogenesis

The present study was undertaken to examine the effects of cyclic administration of low-dose progestogen on endometrial carcinogenesis in mice. A total of 115 female ICR mice, 10 weeks of age, were divided into four experimental and control groups. Mice in groups 1-3 received laparotomy and were injected with N-methyl-N-nitrosourea (MNU) solution at a dose of 1 mg/100 g body weight to the left uterine tube and with normal saline to the right uterine tube. From one week after the MNU exposure, groups 1 and 2 were given 5 ppm 17 beta-estradiol (E2)-containing diet throughout the experiment. Mice in group 1 received 5 s.c. injections of medroxyprogesterone acetate (MPA) (2 mg/mouse) at intervals of 4 weeks from week 7. Group 3 was treated with MNU/normal saline alone. Group 4 consisted of mice treated with MPA alone. At the termination of the experiment (week 30), all animals were killed and autopsied for pathological examinations. It was found that adenocarcinomas and preneoplastic lesions developed in the bilateral uterine corpora in mice of groups 1-3. MPA treatment significantly decreased the weight of the uterine corpus (P < 0.05) and the incidences of endometrial adenocarcinoma and atypical or adenomatous (P < 0.001) but not cystic glandular hyperplasias in the MNU/E2-treated groups. Additionally, MPA treatment tended to decrease the proliferating cell nuclear antigen-labeling index in endometrial glandular cells. These data indicate that MPA, even at low dose, has an inhibitory effect on mouse endometrial carcinogenesis induced by MNU and E2.

Elevated plasma transforming growth factor-beta 1 levels in breast cancer patients decrease after surgical removal of the tumor

OBJECTIVE

The authors determined whether untreated breast cancer patients have elevated plasma levels of transforming growth factor-beta 1 (TGF-beta 1).

SUMMARY BACKGROUND DATA

Increased plasma TGF-beta 1 levels recently were found after chemotherapy in patients with advanced breast cancer. However, it currently is unknown whether this elevation in plasma TGF-beta 1 is caused by chemotherapy-induced normal tissue damage or whether it results from the presence of the tumor.

METHODS

An enzyme-linked immunosorbent assay was used to measure plasma TGF-beta 1 levels in 26 newly diagnosed breast cancer patients before and after definitive surgery. Patients were grouped by postoperative tumor status: 1) negative lymph nodes (group 1); 2) positive lymph nodes (group 2); and 3) overt residual disease (group 3). The site of TGF-beta 1 production in the tumors was localized by immunohistochemistry and in situ hybridization.

RESULTS

Plasma TGF-beta 1 levels were elevated preoperatively in 81% of the patients; TGF-beta 2 and TGF-beta 3 were undetectable. The preoperative TGF-beta 1 levels in the three patient groups were similar; however, the postoperative plasma TGF-beta 1 levels differed by disease status. The mean plasma TGF-beta 1 level in group 1 (n = 12) normalized after surgery (19.3 +/- 3.2 vs. 5.5 +/- 1.0 ng/mL, p < 0.001). In contrast, the mean plasma TGF-beta 1 levels remained above normal in both group 2 (n = 9) and group 3 (n = 5) after surgery. Transforming growth factor-beta 1 expression was found to be preferentially increased in the tumor stroma.

CONCLUSIONS

Breast tumors result in increased plasma TGF-beta 1 levels in 81% of patients. After surgical removal of the primary tumor, the plasma TGF-beta 1 level normalizes in the majority of patients; persistently elevated levels correlate with the presence of lymph node metastases or overt residual tumor. These findings suggest that the usefulness of TGF-beta 1 as a potential plasma marker for breast tumors deserves further study.

Relationship between insulin-dependent diabetes mellitus (IDDM) and non-insulin-dependent diabetes mellitus: beta-cell function, islet cell antibody, and haptoglobin in parents of IDDM patients

To examine the relationship between non-insulin-dependent diabetes mellitus (NIDDM) and insulin-dependent diabetes mellitus (IDDM), we studied beta-cell function, HLA type, and serologic markers of IDDM and NIDDM in the parents of IDDM patients. Fifty-two parents of 33 IDDM patients were examined in terms of islet-cell antibody (ICA) status, haptoglobin phenotype, HLA type, and insulin responses during an oral glucose tolerance test (OGTT). Twenty-seven parents were prospectively evaluated for up to 113 months. They were divided into the following three groups based on pattern of ICA positivity during the follow-up period: group 1, persistently positive ICA (n = 4); group 2, fluctuating ICA (n = 7); and group 3, persistently negative ICA (n = 16). Twenty-three percent (12 of 52) of the parents of IDDM patients had NIDDM, and 12% (six of 52) of the matched controls did. The prevalence of ICA in the parents (11 of 52, 21%) was greater than in normal controls (one of 112, P < .01). Diabetic parents tended to show a higher prevalence of ICA (six of 12, 50%) than nondiabetic parents (six of 40, 15%; P = .06). ICA-positive parents showed higher glucose levels and lower insulin responses than ICA-negative parents. Three of four parents in group 1 slowly progressed to an insulin-dependent state during 25 +/- 3 months of follow-up evaluation. Parents in group 2 and group 3 did not show any changes in glucose levels or insulin responses during the study.(ABSTRACT TRUNCATED AT 250 WORDS)

Rare occurrence of p53 and ras gene mutations in preneoplastic and neoplastic mouse endometrial lesions induced by N-methyl-N-nitrosourea and 17 beta-estradiol

To examine K-, H-, or N-ras and p53 gene mutations in mouse endometrial carcinogenesis induced by N-methyl-N-nitrosourea and 17 beta-estradiol, we performed polymerase chain reaction-single strand conformation polymorphism (PCR-SSCP) in 13 adenocarcinomas and 11 other preneoplastic lesions. A significant shifted band in exon 5 of p53 using PCR-SSCP was detected in one of 13 adenocarcinomas. Direct sequencing showed that the mutation was TCA-to-TGA (Ser-to-End) transition. These results suggest that ras gene mutations were not related to carcinogenesis and inactivation of p53 may occur with low frequency during the mouse endometrial carcinogenesis in this model.

Correction of hypertriglyceridemia with low high-density lipoprotein cholesterol by the novel compound NO-1886, a lipoprotein lipase-promoting agent, in STZ-induced diabetic rats

We have previously reported that the novel compound NO-1886 increased lipoprotein lipase (LPL) activity, with resulting elevation of high-density lipoprotein (HDL) cholesterol in normal rats (J Clin Invest 92:411-417, 1993). The aim of this study was to ascertain whether the compound has the same action in diabetes, because hypertriglyceridemia with low HDL cholesterol is an extremely common concomitant condition in diabetes. Streptozotocin-induced diabetic rats showed marked elevation of plasma triglyceride and reduction of HDL cholesterol. Both single and repeated administration of NO-1886 increased postheparin plasma LPL activity, with resulting reduction of plasma triglyceride and elevation of HDL cholesterol. Repeated administration increased the amount of LPL mRNA in adipose tissue and myocardium. The compound had no effects on plasma glucose and insulin levels. Our study indicates that the compound is potentially beneficial for the treatment of hypertriglyceridemia with low HDL cholesterol in diabetes.

Anterior wedge-shaped bone graft for old scaphoid fractures or non-unions. An analysis of relevant carpal alignment

For appraisal of anterior wedge-shaped grafts for the humpback deformity of the scaphoid, a retrospective study of 27 cases with old scaphoid fractures or non-unions was carried out. 11 cases were treated with Herbert screw fixation and anterior wedge-shaped graft and the other cases with other methods. For the assessment of carpal alignment, radio-lunate and scapho-lunate angles were measured with peri-operative radiographs. For the clinical assessment, the scoring system of Cooney was applied. In 25 cases, primary bone union was obtained with one attempt and in two cases, with the second operation. Union was achieved in a mean of 3.4 months. The post-operative wrist score ranged from 65 to 100 with an average 81.2 points. There was a statistically significant relationship between the wrist score and the post-operative scapho-lunate angulation of the affected wrist. The humpback deformity of scaphoid non-union should be treated precisely with carpal realignment surgery or anterior wedge-shaped bone graft.

Epidermal growth factor stimulates hydrolysis of phosphatidylinositol 4,5-bisphosphate, generation of diacylglycerol and exocytosis in mouse spermatozoa

Mouse spermatozoa stimulated with epidermal growth factor (EGF) or zona pellucida (ZP) experienced phosphatidylinositol 4,5-bisphosphate hydrolysis, diacylglycerol (DAG) generation and acrosomal exocytosis. The agonists showed additive effects but the action of EGF is likely to be mediated by a distinct receptor because maximal stimulation achieved with EGF was enhanced further by ZP. Generation of DAG and exocytosis stimulated by EGF were inhibited by tyrphostin A48, indicating that tyrosine kinase activity mediates EGF action. On the other hand, pertussis toxin did not affect the EGF-induced formation of DAG or exocytosis, ruling out the involvement of sperm Gi-like proteins. These results indicate that EGF could be an important co-factor in the initiation of exocytosis in spermatozoa.

Short communication: normal tissue injury after cancer therapy is a local response exacerbated by an endocrine effect of TGF beta

The sensitivity of normal tissues rather than of the tumour usually limits the effectiveness of cancer treatment. The normal tissue side effects from chemotherapy and/or radiotherapy result from both direct cellular loss and the extensive fibrosis that develops at the site of injury. Recent evidence suggests that the cytokine, transforming growth factor beta (TGF beta), mediates this fibrogenic process. Herein, we provide evidence in support of the hypothesis that the fibrosis formation following therapy results not only from TGF beta produced locally in the injured normal tissue, but also from circulating TGF beta released by the tumour. Thus, therapy-induced normal tissue damage appears in part to be a local manifestation of a systemic condition.

The expression of pituitary adenylate cyclase-activating polypeptide (PACAP) mRNA in rat brain: possible role of endogenous PACAP in vasopressin release

We investigated the expression of pituitary adenylate cyclase-activating polypeptide (PACAP) mRNA in rat brain by in situ hybridization. PACAP mRNA was prominently expressed in arcuate nucleus (ARC). Three days of water deprivation significantly increased plasma arginine vasopressin and markedly potentiated the expression of PACAP mRNA in ARC. These results suggest that PACAP in ARC may play some physiological role, possibly one of which may be the control of vasopressin release.

Prospective study of lipoprotein(a) as a risk factor for atherosclerotic cardiovascular disease in patients with diabetes

OBJECTIVE

To assess whether lipoprotein(a) [Lp(a)] is a risk factor for atherosclerotic cardiovascular disease in diabetes.

RESEARCH DESIGN AND METHODS

We studied 221 patients with non-insulin-dependent diabetes mellitus (NIDDM) without diabetic complications who were followed for 2.2-3.1 years. Their serum Lp(a) levels were semiquantified by a rapid electrophoretic method that accurately discriminates high from low serum Lp(a) at the 20 mg/dl level.

RESULTS

Seven of 105 diabetic patients with a high serum Lp(a) experienced a clinical event related to atherosclerotic cardiovascular disease. This incidence was significantly higher than that of the 110 diabetic patients with a low serum Lp(a). The logistic regression analysis revealed that Lp(a) was an independent risk factor for the event.

CONCLUSIONS

Lp(a) is a significant risk factor for atherosclerotic cardiovascular disease in NIDDM.

[Delayed clearance of methotrexate in a patient with malignant lymphoma who developed renal failure]

Malignant lymphoma of diffuse large cell type, was diagnosed in a 70-year-old man with tumors of the nasal cavity and right testis. He was treated with Epi-VEPA regimen and relapsed in the right thalamus just after achieving remission. Total cranial irradiation was effective, but multiple skin lesions were present at the time. He then suffered from renal failure and delayed clearance of MTX after high-dose methotrexate (MTX) administration with citrovorum factor (CF). The serum concentration of MTX decreased to 0.09 microM within 285 hours by multi-clearance techniques as continuous arteriovenous hemoperfusion (CAVH), plasma exchange (PEX), peritoneal dialysis (PD) and charcoal hemoperfusion (CH). Better MTX clearance was observed in CH and PEX than in CAVH and PD, with higher effect in PEX than in CH or CAVH. The patient suffered severe mucositis and myelosuppression, but fatal harm of MTX was prevented. CH and PD were considered the best combination of clearance techniques for removing serum MTX in delayed methotrexate clearance with renal disturbance.

Changes in plasma transforming growth factor beta in response to high-dose chemotherapy for stage II breast cancer: possible implications for the prevention of hepatic veno-occlusive disease and pulmonary drug toxicity

Veno-occlusive disease (VOD) of the liver and pulmonary drug toxicity (PDT) are two major complications of high-dose chemotherapy and autologous bone marrow transplantation (BMT) for solid tumors. We have previously demonstrated that an elevated plasma TGF-beta concentration before transplant predicts the later occurrence of these complications. In the present study, we used a simplified enzyme-linked immunosorbant assay (ELISA) to prospectively evaluate the kinetics of plasma TGF-beta concentrations of 45 patients with stage II breast cancer who underwent high-dose chemotherapy and autologous BMT. We demonstrated that, of the three TGF-beta isoforms, only TGF-beta 1 was present in the plasma. Pre-transplant plasma TGF-beta 1 was significantly higher in patients with VOD and PDT compared with that in patients without these complications. The plasma TGF-beta 1 level in patients who later developed VOD or PDT decreased to that of controls within 2 days of initiating high-dose chemotherapy; this decrease was not correlated with platelet concentration changes. These results suggest that interventions aimed at preventing the development at VOD or PDT must be given early in the course of high-dose chemotherapy.

[Chemoprophylaxis of bacterial infections in granulocytopenic patients with new quinolone: a comparison of trimethoprim-sulfamethoxazole (ST) alone with ST plus ciprofloxacin]

Fifty-three granulocytopenic patients were studied in a randomized trial comparing trimethoprim-sulfamethoxaxole (ST) alone with ST + ciprofloxacin (CPFX) for prevention of bacterial infections. Seventeen febrile episodes occurred in 24 patients receiving ST alone, and 9 febrile episodes occurred in 29 patients receiving ST + CPFX. ST + CPFX was significantly effective than ST alone (p < 0.005). Although ST alone was effective to prevent infections in moderately granulocytopenic patients, it could not prevent infections in severely granulocytopenic patients whose minimal granulocyte count was less than 250/microliters during prophylactic treatment. In contrast, ST + CPFX was effective in severely as well as in moderately granulocytopenic patients. Clinically significant adverse reactions were not observed in both regimens. These results suggest that combination with ST and CPFX is more efficacious than ST alone for the prevention of bacterial infections in granulocytopenic patients.

Exocytosis in spermatozoa in response to progesterone and zona pellucida

Exocytosis in mammalian spermatozoa (the acrosome reaction) is a process essential for fertilization. Both progesterone and zona pellucida induce exocytosis in spermatozoa, which may encounter both during penetration of the oocyte's vestments. When mouse spermatozoa were exposed first to progesterone and then to zona pellucida, exocytosis was enhanced to a greater degree than that seen when the agonists were presented together or in the inverse order, which suggests that the steroid exerts a priming effect. Progesterone similarly primed the generation of intracellular messengers evoked by zona pellucida. The effects triggered by progesterone were mimicked by gamma-aminobutyric acid (GABA) and were blocked by bicuculline, which indicates that the steroid acts on a GABAA receptor.

[Primary lipoprotein lipase deficiency: clinical and genetic aspects]

Primary deficiency of the enzyme lipoprotein lipase (LPL) is an autosomal recessive disorder characterized by chylomicronemia, recurrent pancreatitis and xanthomas. In recent years, a growing number of mutations have been identified in patients with this inherited disorder and molecular defects include insertions and deletions, splicing defects, and nonsense and missense mutations. Most of these mutations are clustered in the region encoded by exon 4, 5 and 6 which forms the catalytic domain of LPL. The study of these mutations also contributes to our understanding of the structure, function relationships of the enzyme.

Alteration of p53 gene in ovarian carcinoma: clinicopathological correlation and prognostic significance

Inactivation of the tumour-suppressor gene p53 has been demonstrated in a variety of human tumours. We extracted DNA from paraffin-embedded tissues of 67 ovarian carcinoma samples (54 primary tumours, seven metastases and six tumours obtained after chemotherapy), and analysed allelic losses and mutations of the p53 gene using single-strand conformation polymorphism (SSCP) analysis of DNA fragments amplified by a polymerase chain reaction (PCR). Allelic loss was observed in 24 of 32 informative cases. The mutation was detected in 14 of 54 primary ovarian carcinomas: eight serous cystadenocarcinomas (SCA), 42%), five endometrioid adenocarcinomas (EA, 42%) and one mucinous cystadenocarcinoma (14%). The incidence of the alteration was higher in SCA and EA than in other histological types, but the difference was not statistically significant. The incidence of p53 gene abnormalities in ovarian carcinomas tended to be increased in patients with disease advanced (over FIGO stage II). Mutations were found in exons 5 and 7 only and consisted mainly of single nucleotide substitutions [9 or 14 (64%) in exon 7; 4 of 14 (29%) in exon 5]. In 13 of 14 cases, p53 gene mutations occurred concomitantly with losses of the normal allele. The status of the p53 gene in metastases and the tumours obtained after chemotherapy was identical to that in the primary tumours. The presence of p53 gene mutation did not correlate with histological grade, response to primary therapy and survival. These findings suggest that mutational alterations of the p53 gene are involved in the development of a significant proportion of some ovarian carcinomas (SCAs or EAs), especially in advanced stages. However, they may not be a marker predicting the biological behaviour or the outcome of the disease.

[A familial case of prostate cancer in three brothers]

We treated three brothers for prostate cancer. The first brother developed the disease of poorly differentiated adenocarcinoma at the age of 76, and was treated with endocrine therapy but died of recurrent cancer at age 80. The second brother was diagnosed poorly differentiated adenocarcinoma at age 75, and he is alive at age 80 without recurrence after endocrine therapy. The third brother developed moderately differentiated adenocarcinoma at age 58, and was treated with endocrine therapy but died of recurrent cancer at age 73. We have seen few familial cases of prostate cancer. The first such case is reported here in Japan. Eleven similar cases of familial prostate cancer involving three or more brothers have been reported in the Western literature.

Changes in plasma TGF beta levels during pulmonary radiotherapy as a predictor of the risk of developing radiation pneumonitis

PURPOSE

To determine whether plasma transforming growth factor-beta (TGF-beta) levels measured before and during radical radiotherapy for lung cancer could be used to predict patients at risk for the development of radiation pneumonitis.

METHODS AND MATERIALS

The first eight patients with lung cancer (nonsmall cell: seven, small cell: one) enrolled in a prospective study designed to evaluate physiological and molecular biologic correlates of radiation induced normal tissue injury are described. The study began in June 1991. All patients were treated with radiotherapy with curative intent. Plasma transforming growth factor-beta levels were obtained before, weekly during, and at each follow-up after treatment. Pretreatment pulmonary function tests and single photon emission computed tomography scans were obtained to assess baseline lung function and were repeated at follow-up visits. Dose-volume histogram analyses were performed to determine the volume of lung which received > or = 30 Gy. Patients were assessed at each follow-up visit for signs and symptoms of pneumonitis.

RESULTS

Five patients developed signs and/or symptoms of pulmonary injury consistent with pneumonitis and three patients did not. In all three patients not developing pneumonitis, plasma TGF-beta levels normalized by the end of radiotherapy. In contrast, four out of five patients who suffered pneumonitis had persistently elevated plasma TGF-beta levels by the end of therapy. This finding appeared to be independent of the volume of irradiated lung.

CONCLUSIONS

These results suggest that plasma TGF-beta levels during treatment may be useful to determine which patients are at high risk of developing symptomatic pneumonitis following thoracic radiotherapy. This finding may have implications when planning additional therapy (either chemotherapy or radiotherapy) which may have potentially adverse consequences on the lung.

Plasma lipid abnormalities and risk factors for coronary artery disease in Japanese subjects with diabetes mellitus and glucose intolerance

We evaluated the plasma lipid levels of 3163 subjects including subjects with non-insulin-dependent diabetes mellitus (NIDDM), insulin-dependent diabetes mellitus (IDDM), impaired glucose tolerance (IGT), and normal glucose tolerance. Furthermore, we performed 100 g oral glucose tolerance tests on 2113 subjects, and analyzed the relationships of risk factors for coronary artery disease to glucose intolerance. Mean plasma cholesterol and triglyceride levels were highest in NIDDM (213 mg/dl and 148 mg/dl), and plasma HDL-cholesterol level was lowest in IGT and NIDDM (42 mg/dl), as compared to those in normal subjects (cholesterol, 200 mg/dl; triglycerides, 109 mg/dl; HDL-cholesterol, 52 mg/dl). Multiple regression analysis demonstrated a significant relationship of either blood pressure, plasma triglyceride or HDL cholesterol level to plasma insulin and glucose response after glucose loading.

Polyphosphoinositide-derived diacylglycerol stimulates the hydrolysis of phosphatidylcholine by phospholipase C during exocytosis of the ram sperm acrosome. Effect is not mediated by protein kinase C

In ram spermatozoa, treatment with the ionophore A23187 and Ca2+ led to an increase in total diacylglycerol mass and to exocytosis of the acrosomal granule. If sperm cells were prelabeled with [3H]palmitic acid, stimulation with A23187/Ca2+ resulted in the generation of [3H]diacylglycerols with a mixture of saturated and unsaturated fatty acids. When cells were prelabeled with 1-O-[3H]octadecylglycerophosphocholine, stimulation led to the generation of [3H]alkylacylglycerol. No rise in [3H]diacyl- or [3H]alkylacylphosphatidic acid was detected under these conditions. Moreover, no changes in the mass of phosphatidic acid have been previously noted under similar conditions. Thus, these results indicate that diradylglycerols are generated via phospholipase C (PLC). Increases in diradylglycerols were paralleled by rises in monoacyl- or monoalkylglycerols labeled at position 1, but not in free [3H]palmitic acid or [3H]octadecanol, implying that, unlike somatic cells, spermatozoa catabolize diradylglycerols via a 2-diglyceride lipase. Activation of PLC appears to be effected by phosphoinositide-derived diacylglycerol: exposure to Mg2+, a cation known to inhibit phosphoinositide hydrolysis, resulted in less PLC activity upon stimulation, and addition of exogenous 1,2-diacylglycerols enhanced the enzyme's activity. However, 1,3-diacylglycerol and alkylacylglycerol also stimulated PLC activity, suggesting that the effect is unlikely to be mediated via protein kinase C. Since diradylglycerols are known to be essential in the molecular sequence leading to membrane fusion in mammalian spermatozoa, these results suggest that their generation via PLC constitutes a fundamental event during acrosomal exocytosis in response to physiological agonists.

Lack of association of the transporter associated with antigen processing with Japanese insulin-dependent diabetes mellitus

The transporter associated with antigen processing (TAP) encoded in the major histocompatibility complex (MHC) class II region is a molecule required for endogenous antigen processing. We have typed TAP polymorphism in 95 Japanese patients with insulin-dependent diabetes mellitus (DDM) and 75 normal controls. Amino acid substitutions at positions 333 and 637 of TAP1 and at positions 379, 665, and 687 of TAP2 were typed by the polymerase chain reaction (PCR)-sequence-specific oligonucleotide method. In addition, DNA typing of human leukocyte antigen (HLA)-DQA1 and -DQB1 loci was performed by the PCR-restriction fragment length polymorphism method. There was no significant difference between IDDM patients and normal controls in the frequencies of TAP1 and TAP2 alleles. On the contrary, the HLA-DQ locus showed a strong association with IDDM in the same series of subjects. The frequencies of HLA-DQA1*0301 and -DQB1*0401 were increased significantly and those of HLA-DQA1*0103, -DQB1*0501, -DQB1*0601 and -DQB1*0602 were decreased significantly in Japanese IDDM patients compared with normal controls. Positive linkage disequilibrium was observed between HLA-DQB1*0303 and TAP2C and between HLA-DQB1*0401 and TAP2B. Negative linkage disequilibrium was observed between HLA-DQA1*0103 and TAP2A. Even when subjects with HLA-DQA1*0103, -DQA1*0301, -DQB1*0302, -DQB1*0303, and -DQB1*0401 were considered separately, no significant differences was found in the distribution of TAP1 and TAP2 alleles between IDDM patients and normal controls. We conclude that it is not TAP but HLA-DQ that exhibits a primary association with Japanese IDDM.