cDNA cloning and mRNA expression of a serine proteinase inhibitor secreted by cancer cells: identification as placental protein 5 and tissue factor pathway inhibitor-2

A serine proteinase inhibitor was purified from conditioned medium of the human glioblastoma cell line T98G. Analysis of its partial amino acid sequences indicated that this protein was identical to placental protein 5 (PP5), a placenta-derived glycoprotein with serine proteinase inhibitor activity, the amino acid sequence of which had been partially determined. cDNA cloning of PP5 demonstrated that it belonged to the Kunitz-type serine proteinase inhibitor family, having three putative Kunitz-type inhibitor domains, and that it was identical to a recently reported inhibitor, tissue factor pathway inhibitor-2 (TFPI-2) [Sprecher et al. (1994) Proc. Natl. Acad. Sci. USA 91, 3353-3357]. PP5/TFPI-2 transcripts were highly abundant in the full-term placenta and widely expressed in various adult human tissues, such as the liver, skeletal muscle, heart, kidney, and pancreas. Several ovarian carcinoma cells as well as T98G also contained significant amounts of the transcripts.

Cross-reactivity of IgM- and IgG-secreting B cells in murine chronic graft-versus-host reaction

A chamber ELISpot assay was used to measure the frequency with which in vivo activated B cells secreted cross-reactive antibodies during a chronic graft-versus-host reaction in mice. Both normal (C57BL/10 x DBA/2)F1 mice and F1 recipients of syngeneic spleen cells (SynF1) expressed repertoires in which 13-17% of IgM and 3-5% of IgG-secreting cells were cross-reactive. By comparison, 43-55% of IgM and 9-40% of IgG-secreting cells from F1 recipients of parental DBA/2 spleen cells (GVHF1) were cross-reactive (P < 0.01, GVHF1 versus F1 or SynF1). The cross-reactivity of the GVHF1 IgM secreting cells remained elevated for > 2 months following cell transfer. In contrast, the cross-reactivity of IgG-secreting cells, which was significantly high at Week 3 post-transfer, declined to nearly normal levels by Week 9. These findings demonstrate that cross-reactive B cells constitute an abnormally large fraction of the repertoire expressed by mice with chronic GVHR in a period when B cell hyperstimulation was occurring.

Treatment with dextran-conjugated anti-IgD delays the development of autoimmunity in MRL-lpr/lpr mice

The onset of clinical disease in autoimmune MRL-lpr/lpr mice is preceded by a switch from predominantly IgM production to IgG production. Previous studies have shown that IgG autoantibodies play a central role in the development of life-threatening glomerulonephritis in this strain. Delaying or preventing the switch from IgM to IgG production might therefore be of therapeutic benefit. We previously documented similarities in the B cell repertoire expressed by young MRL-lpr/lpr mice and normal mice treated with the polyclonal activator LPS. Recent in vivo studies indicate that cross-linking membrane IgM or IgD can suppress LPS-dependent IgG production in normal animals. These observations led us to examine whether membrane cross-linking could also lower serum IgG levels in MRL-lpr/lpr mice. Lupus-prone animals were treated with multivalent anti-IgD conjugated to high m.w. dextran. This anti-IgD dextran conjugate was previously shown to reduce IgG production in LPS-stimulated normal animals. Treatment of young lupus-prone MRL-lpr/lpr mice resulted in a significant reduction in the total number of B cells secreting IgG and lower serum titers of IgG anti-DNA and IgG anti-histone autoantibodies. Anti-IgD dextran treatment also delayed the development of glomerulonephritis and improved survival. Thus, anti-IgD dextran interfered with autoantibody-dependent disease progression, perhaps by inhibiting the switch from IgM to IgG autoantibody production.

Treatment with dextran-conjugated anti-IgD delays the development of autoimmunity in MRL-lpr/lpr mice

The onset of clinical disease in autoimmune MRL-lpr/lpr mice is preceded by a switch from predominantly IgM production to IgG production. Previous studies have shown that IgG autoantibodies play a central role in the development of life-threatening glomerulonephritis in this strain. Delaying or preventing the switch from IgM to IgG production might therefore be of therapeutic benefit. We previously documented similarities in the B cell repertoire expressed by young MRL-lpr/lpr mice and normal mice treated with the polyclonal activator LPS. Recent in vivo studies indicate that cross-linking membrane IgM or IgD can suppress LPS-dependent IgG production in normal animals. These observations led us to examine whether membrane cross-linking could also lower serum IgG levels in MRL-lpr/lpr mice. Lupus-prone animals were treated with multivalent anti-IgD conjugated to high m.w. dextran. This anti-IgD dextran conjugate was previously shown to reduce IgG production in LPS-stimulated normal animals. Treatment of young lupus-prone MRL-lpr/lpr mice resulted in a significant reduction in the total number of B cells secreting IgG and lower serum titers of IgG anti-DNA and IgG anti-histone autoantibodies. Anti-IgD dextran treatment also delayed the development of glomerulonephritis and improved survival. Thus, anti-IgD dextran interfered with autoantibody-dependent disease progression, perhaps by inhibiting the switch from IgM to IgG autoantibody production.

Analysis of knee movement with low-field MR equipment--a normal volunteer study

This study was performed to make a normal standard by analyzing normal knee movement in detail. An open low-field unit was used for 23 healthy knee joints. With three-dimensional Fourier transformation (3DFT) gradient echo sequence, 50 sagittal slices of 4.5 mm in thickness were obtained at four flexion angles: 0, 30, 60, and 90 degrees (lateral position). Although the tension ratio of the anterior and posterior cruciate ligaments (ACL, PCL) increased during knee flexion, the change in the tension ratio was significantly different between the ACL and PCL. The femur-ACL angle and femur-PCL angle were parallel with the knee flexion angle, but the tibia-ACL angle and tibia PCL angle changed complexly. The lateral and medial condyles rolled and slid during knee flexion, and the medial side moved more than the lateral side, consistent with rotation of the lower thigh. The difference in backward movement distance on the tibia between the two condyles was significantly larger in females than in males. This might explain the dominance of knee osteoarthritis in women. Although the lateral position is not completely physiological, we could show initial cinematic data of up to 90 degrees of knee flexion using open-type MRI, which is impossible with high- and middle-field machines.

Stimulatory effect of human insulin on erythroid progenitors (CFU-E and BFU-E) in human CD34+ separated bone marrow cells and the relationship between insulin and erythropoietin

Erythropoietin is known to be effective for the treatment of anemia in chronic renal failure, but the efficacy of erythropoietin for anemia in other diseases is not so great. Insulin exerts a growth promoting activity in various kinds of cells. In the present study, the effects of insulin on erythroid progenitors (colony forming units-erythroid, CFU-E; and burst forming units-erythroid, BFU-E) in human bone marrow were examined at various concentrations of recombinant human erythropoietin (rh-Epo) to clarify the relationship between erythropoietin and insulin. Human insulin stimulated the formation of CFU-E and BFU-E in the presence of three concentrations (0.25, 5, and 100 U/ml) of rh-Epo. Stimulatory effects of human insulin on CFU-E and BFU-E were also observed in the nonphagocytic and nonadherent bone marrow fraction (NP-NA fraction) and in the NP-NA and T cell-depleted fraction at each concentration of rh-Epo. Human insulin further stimulated the CFU-E and BFU-E growth in CD34+ separated bone marrow cells. These results indicate that the enhancing effect of human insulin on erythroid progenitors is not mediated through monocytes and macrophages or T cells, suggesting a direct action on erythroid progenitors.

Pruritic papular eruption of the acquired immunodeficiency syndrome

We report a case of acquired immunodeficiency syndrome with pruritic papular eruption. The patient, a hemophiliac, presented with generalized pruritic, skin-colored papules and nodules. The chronic lesions were excoriated and hyper-pigmented. The eosinophil count was elevated, but IgE was normal. The lesions and pruritus responded only to ultraviolet B phototherapy. While the mechanism is not known, ultraviolet B phototherapy may provide relief of AIDS-related pruritus.

Chromophobe renal cell carcinoma: a report of two cases

Chromophobe renal cell carcinoma (RCC) is a recently established subtype of RCC, which has rarely been reported in Japan. In this communication, the authors report two Japanese cases of chromophobe RCC together with the immunohistochemical findings. The tumors were composed of sheets and cribriform glands formed by tumor cells with cloudy and reticular cytoplasm. Ultrastructurally, the cytoplasm was filled with numerous microvesicles. The tumor cells were positive for cytokeratin, epithelial membrane antigen, and Tamm-Horsfall protein. Occasionally, LeuM1-positive cells were also noted. Vimentin was negative, unlike the usual RCC. Reactivity for peanut agglutinin was more frequent than that to Lotus tetragonolobus agglutinin. The results of this study suggest that the tumor cells possessed phenotypes similar to the distal nephron rather than to the proximal tubular cells.

Acute abdominal symptoms caused by hemorrhagic necrosis of a pheochromocytoma: report of a case

The diagnosis of pheochromocytoma is often difficult in a patient presenting with acute illness but without the classical constitutional symptoms. We report herein the case of a woman who developed acute abdominal symptoms following hemorrhagic necrosis of a previously unsuspected pheochromocytoma. This patient underwent successful emergency resuscitation followed later by elective surgical resection of a right adrenal pheochromocytoma. A review of 27 other cases indicates that a fatal outcome is likely to result without the initiation of prompt and appropriate emergency treatment, followed later by removal of the tumor. Thus, early diagnosis is important not only for controlling hypertension, but also because performing a laparotomy on a patient with unrecognized hemorrhagic necrosis of pheochromocytoma can create a potentially lethal situation.

Establishment and characterization of a malignant melanoma cell line (YP-MEL) derived from a patient with neurocutaneous melanosis

A cell line, YP-MEL, was established from an intracranial malignant melanoma occurring in a neurocutaneous melanosis (NCMsis) patient. The established cell line was successfully cultured in serum-free medium with a doubling time of 41 h. The cells were refractile and small in size, with occasional pigmented giant cells. Histochemical and immunohistochemical features were compatible with common malignant melanoma and its cell line. Chromosome analysis revealed many supernumerary chromosomes and marker chromosomes including double minutes (DMs). When transplanted into nude mice, YP-MEL formed tumors histologically consistent with the original tumor. Addition of sera to the medium caused cellular spreading and elongation of cytoplasmic processes with an increase of melanin contents and tyrosinase activity. Because there was no melanoma cell line derived from a NCMsis patient, YP-MEL might be a beneficial tool for study on NCMsis.

Analysis of responsive cells in tolerance by the oral administration of ovalbumin

The induction of immune tolerance is the most common consequence of protein feeding, i.e., "oral tolerance". In this study we investigated the genetic basis of oral tolerance using various kinds of recombinant and congenic mice, and the cells involved in the development of this phenomenon in mice. The footpad swelling response to ovalbumin (OVA) was inhibited in mice that were orally fed OVA 7 days before sensitization. No effect of strain of mouse was seen in this inhibition. This inhibition could be transferred by Peyer's patch cells. The CD4-8+ T cells were responsible for the inhibition of footpad swelling. The number of CD4+ cells from OVA-fed tolerant mice decreased significantly, but CD8+ cells did not. The number of CD4-8+ T cells was increased in Peyer's patches of OVA-fed tolerant mice, and were involved in the development of oral tolerance.

[Clinical study of fluconazole for systemic fungal infections with hematological disorders]

Fluconazole (FLCZ) was administered orally or intravenously to 161 patients with systemic fungal infections complicated with hematological disorders and it was possible to evaluate clinical efficacies in 109 patients. Systemic fungal infections were documented in 48 patients and suspected in 61 patients. The overall clinical efficiency rates were 43.8% (21/48) in patients with documented fungal infections, and 55.7% (34/61) in patients with suspected fungal infections. Therefore, the overall clinical efficacy rate was 50.5% (55/109). Side effects were observed in 5 patients with an incident rate of 3.1% (5/161), but there was none of them was serious. These results indicate that FLCZ is an agent with good potential in treatment of systemic fungal infections in patients with hematological disorders.

Polyclonal B cell activation and antigen-specific stimulation in mice with chronic graft-versus-host reaction

Primary chronic graft-versus-host reaction (GVHR) was induced in (C57BL/10 x DBA/2)F1 (BDF1) mice via the transfer of parental DBA/2 derived lymphocytes. A significant increase in the absolute number of IgM- and IgG-secreting cells was found in recipient BDF1 mice at 3 weeks post-transfer. The increase included B cells reactive with both self- and non-self-antigens, without being skewed toward the production of autoantibodies. Later in the disease process (approximately 6-8 weeks post-transfer), we detected an increased number of B cells that secreted antibodies reactive with a select subset of autoantigens in about 30% of BDF1 recipients (3 of 9 mice). These findings suggest that not only antigen-specific stimulation, which was detected in a late stage, but also initial polyclonal activation may account for chronic GVHR.

Sensitive high-performance liquid chromatographic determination of 2,2'-[(2-aminoethyl)imino]diethanol bis(butylcarbamate) and its metabolites in human serum following pre-column derivatization with o-phthalaldehyde and stabilization of the derivatives

A high-performance liquid chromatographic method for the sensitive determination of 2,2'-[(2-aminoethyl)imino]diethanol bis(butylcarbamate) (I) and its metabolites in human serum has been developed. The method was based on a pre-column derivatization with o-phthalaldehyde. The derivatives were stabilized at least for 24 h at 4 degrees C by using N-acetyl-L-cysteine as a thiol and by eliminating the excess o-phthalaldehyde in the reaction mixture by solvent extraction and the addition of an ammonium salt after the reaction. The recoveries and reproducibilities in human serum spiked with I and its two metabolites were satisfactory, and the responses were linear over a wide range of analyte concentrations. The detection limits of I and its metabolites, II and III, in serum were 0.5, 4 and 2 ng/ml, respectively, at a signal-to-noise ratio of 5. The method was satisfactorily applied to the clinical study of I.

Three-dimensional study of glomerular lesions in murine chronic graft-versus-host reaction by the quick-freezing and deep-etching method

In murine chronic graft-versus-host reaction (GVHR), the immune complex composed of antoantibodies has been considered to induce human lupus-like nephritis. We prepared the replica membranes and immunoelectron-microscopic specimens of glomeruli of GVHR mice. The immunoelectron-microscopic examination revealed that immune deposits were noted mainly in the mesangial matrices and subepithelial area. The replica membranes showed various sizes of the deposits in the same portions. Moreover, fine fibrils around the deposits were strongly disrupted. Microfilaments were increased in the cytoplasm of podocytes and endothelial cells were slightly detached from glomerular basement membrane. In this model system, the immune deposits might play an important role in keeping the glomerular integrity.

Genetic control of delayed-type hypersensitivity to chromium chloride

Genetic control of delayed-type hypersensitivity (DTH) to chromium chloride antigen was studied in various strains of mice. Mice with I-Ab,d,f,k,r were high magnitude responders, whereas those with I-Aq,s were low magnitude responders. Studies with recombinant strains indicate that chromium chloride DTH may be influenced by the I-A region of H-2. DTH to chromium chloride is an antigen-specific response. We further revealed that response to chromium chloride does not cross-react with response to cobalt or nickel chloride. Also, transfer experiments using lymph node cells suggest that these responses are mediated by CD4+8-, Ia-T cells.

Responsiveness of bone marrow erythroid progenitors (CFU-E and BFU-E) to recombinant human erythropoietin (rh-Ep) in vitro in multiple myeloma

The responsiveness of bone marrow erythroid progenitors (CFU-E and BFU-E) to recombinant human erythropoietin (rh-Ep) was investigated in vitro in 21 patients with multiple myeloma to assess the clinical usefulness of rh-Ep in this disease. CFU-E and BFU-E assays were performed by methylcellulose culture methods. The myeloma patients were divided into two groups according to the percentage of plasma cells in the bone marrow (over 50% and under 50%). Among the patients with few plasma cells, some revealed normal CFU-E and BFU-E growth at 2 units of rh-Ep, and no further increase was observed even with an increasing dose of rh-Ep. Among the other patients, more than half demonstrated a good response to rh-Ep. Among the patients with a high percentage of plasma cells, some revealed no response to rh-Ep, but there were patients with a high percentage of plasma cells in the bone marrow who had a good response to rh-Ep. High doses of rh-Ep may be clinically effective in some patients with multiple myeloma independently of the level of plasma cells in the bone marrow.

[Clinical evaluation of sulbactam/cefoperazone for severe infections associated with hematological disorders]

The combination therapy of sulbactam/cefoperazone (SBT/CPZ) and piperacillin (PIPC) was evaluated in 49 patients with severe infections associated with hematological disorders. Clinical responses in 43 evaluable patients out of the 49 patients were excellent in 12, good in 18, thus, overall efficacy rate was 69.8% (excellent plus good). Efficacy rates of this combination therapy were 60% (3/5) for sepsis, 75% (21/28) for suspected sepsis, and 50% (4/8) for pneumonia. The efficacy rate was 71.4% (10/14) in patients with neutrophil counts less than 200/microliters; this combination therapy was highly effective even in the neutropenic patients. Transient increases in hepatic function test values were observed in 2 patients, but no other side effects were observed during the combination therapy. From these observations it appears that the combination therapy of SBT/CPZ and PIPC is a very useful empiric therapy for severe infections associated with hematological diseases.

Glomerulonephritis induced by murine chronic graft-versus-host reaction

Severe glomerulonephritis was induced successfully in (B10 x DBA/2)F1 (BDF1) mice by injection of parental DBA/2 lymphoid cells. The mice manifested typical nephrotic syndrome dying around 10 weeks post injection. Electron microscopical examination demonstrated electron dense deposits first in the mesangial matrix, then in the subepithelium compatible with immune complex glomerulonephritis. Subendothelial deposits were not observed. Immunofluorescent study revealed IgG deposition in the capillary wall and IgM in the mesangium early in the process. As the lesion progressed, both IgG and IgM were present in the mesangial area and along the capillary wall. Some glomeruli showed segmental mesangiolysis, suggesting that altered mesangial cells have a role in the development of glomerular change, which together with rise in serum anti-DNA antibody titer suggest that autoantibodies promote the glomerular lesions in this model system.

A correlation between IgG class antibody production and glomerulonephritis in the murine chronic graft-versus-host reaction

A graft-versus-host reaction (GVHR) was induced in (B10 x DBA/2)F1 (BDF1) and (BALB/c x A)F1 (CAF1) murine recipients by injection of their parental or B10.D2-derived spleen cells. The incidences of glomerulonephritis and autoantibody production were then correlated. All of the BDF1 mice that received DBA/2 spleen cells (termed DBA/2----BDF1) and 33% of the CAF1 mice that received BALB/c spleen cells (BALB/c----CAF1) developed glomerulonephritis. However, in other combinations (B10.D2----BDF1, A/J----CAF1) no significant glomerular lesions were observed. An analysis of antibodies by ELISA revealed that the groups with renal disease showed a significant polyclonal elevation of IgG class antibodies, including autoantibodies (anti-DNA, anti-MRBC, and NTA) and a conventional antibody (anti-TNP-KLH). No significant IgG class antibody production was observed in the groups that did not develop glomerulonephritis. Thus, it was suggested that an IgM to IgG class switch is important in the development of glomerulonephritis in GVHR. Other factors also appear to be involved. Only 33% of BALB/c----CAF1 developed glomerulonephritis, even though a level of IgG class antibody production was comparable to that observed in DBA/2----BDF1 in which 100% showed severe glomerulonephritis.

Determination of manidipine enantiomers in human serum using chiral chromatography and column-switching liquid chromatography

A stereoselective and highly sensitive method using chiral chromatography and successive column-switching liquid chromatography is described for the determination of manidipine enantiomers in human serum. A human serum sample obtained after ingestion of manidipine was extracted twice with a mixture of n-hexane-diethyl ether under alkaline conditions. The enantiomers in the extract were separated on a chiral stationary phase column (Chiralcel OJ), and the effluents containing the respective enantiomers were collected. Each fraction was then analysed by column-switching liquid chromatography. The proposed stereoselective method offered high sensitivity: detection limits for both isomers were 0.2 ng/ml in human serum, both at a signal-to-noise ratio of 3. The method is suitable for the pharmacokinetic studies of manidipine enantiomers.

High-performance liquid chromatographic determination of lansoprazole and its metabolites in human serum and urine

A simple and sensitive high-performance liquid chromatographic method with ultraviolet detection is described for the simultaneous determination of lansoprazole and its metabolites in human serum and urine. The analytes in serum or urine were extracted with diethyl ether-dichloromethane (7:3, v/v) followed by evaporation, dissolution and injection into a reversed-phase column. The recoveries of authentic analytes added to serum at 0.05-2 micrograms/ml or to urine at 1-20 micrograms/ml were greater than 88%, with the coefficients of variation less than 7.1%. The minimum determinable concentrations of all analytes were 5 ng/ml in serum and 50 ng/ml in urine. The method was successfully applied to a pharmacokinetic study of lansoprazole in human.