Expression of OKM5 antigen on epidermal cells in mycosis fungoides plaque stage

To characterize and quantitate potential antigen-presenting cell subsets in the epidermis of patients with cutaneous T-cell lymphoma, epidermal cells in suspension were obtained from involved and uninvolved skin. Involved epidermis contained increased numbers of OKT6+HLA-DR+ Langerhans cells and a variable number of OKM5+ epidermal cells (ECs) in all mycosis fungoides (MF) patients tested (N = 14). The OKM5+ EC population from involved epidermis of MF patients were heterogeneous and comprised both OKM5+HLe1- keratinocytes and OKM5+HLe1+ leukocytes. Uninvolved epidermis, in 6 of 14 patients with MF, contained a small number of OKM5+ leukocytes; however, no OKM5+ keratinocytes were detected. Neither OKM5+ leukocytes nor OKM5+ keratinocytes were detected in the epidermis obtained from healthy controls. The increased number of potential antigen-presenting cells, that is, OKT6+HLA-DR+ Langerhans cells and OKM5+HLA-DR+ monocytic leukocytes, in the epidermis of patients with MF may be important for the activation of abnormal T cells contained within the epidermis of these patients. Such activated T cells may release gamma-interferon and induce expression of both HLA-DR and OKM5 antigens on keratinocytes. OKM5+ keratinocytes are present in the epidermis of patients with MF, but not in normal skin, and may thus play a role in the pathogenetic mechanisms of mycosis fungoides by recruitment of immunocompetent cells to the epidermis.

The effects of high-dose glucocorticoid administration on serum bone gamma carboxyglutamic acid-containing protein, serum alkaline phosphatase and vitamin D metabolites in normal subjects

The effects of 40 mg of prednisone given daily for 5 days to normal individuals on serum levels of bone Gla-protein (BGP), alkaline phosphatase, calcium phosphate, 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D and immunoreactive parathyroid hormone (S-iPTH) and on renal excretions of calcium, phosphate and hydroxyproline were evaluated in a double-blind, placebo controlled study. In the prednisone group a 75% decrease (P less than 0.001) was found in serum BGP compared to a 6% decrease (P less than 0.05) in serum alkaline phosphatase. The renal hydroxyproline excretion remained unchanged. Serum calcium was unchanged while the fasting urinary calcium excretion showed a 2-fold increase (P less than 0.001). Serum 1,25-dihydroxyvitamin D increased (P less than 0.01) in spite of unchanged serum 25-hydroxyvitamin D, serum phosphate and parathyroid function (as judged by S-iPTH and the maximal tubular reabsorption capacity for phosphate (TmP/GFR]. The data suggest a direct inhibition of osteoblast number and/or function by short-term glucocorticoid administration with unchanged bone resorption leading to a negative bone mineral balance. The increase in serum 1,25-dihydroxyvitamin D is probably due to a direct stimulation by glucocorticoids of the renal 1 alpha-hydroxylase. The effects of the vitamin D metabolite, however seem to be blunted.

Distinction between proximal and distal regulations of sodium and potassium excretion in humans

The clearances of creatinine (CCr), lithium (CLi), sodium (CNa), and potassium (CK) were determined during three consecutive 2-hour periods in a large number of physically healthy persons who were in lithium treatment for manic-depressive illness. CLi was used as a measure of the proximal tubular fluid output (Vprox). CLi showed considerable spontaneous variations from one 2-hour period to another, and neither bladder emptying errors nor changes of CCr could account for these. The variations of CLi, which reflected variations of Vprox, resulted in joint variations of CNa and CK. Also the ratios CNa/CLi and CK/CLi, which reflected the distal handling of sodium and potassium, showed considerable spontaneous variations. These were correlated neither with each other nor with variations of CLi. Our study indicates that through the use of CLi as a measure of Vprox it is possible to distinguish between a single joint proximal regulation and two separate distal regulations of sodium and potassium excretion. Further studies concerning the interplay between proximal and distal regulations under normal and pathological conditions may provide deeper insight into the way in which the kidney functions.

Bone turnover in spinal osteoporosis

We have investigated biochemical indices of bone formation and bone resorption: serum alkaline phosphatase (sAP) plasma bone Gla protein (pBGP), fasting urinary hydroxyproline corrected for creatinine (FuHP/Cr), and fasting urinary calcium corrected for creatinine (FuCa/Cr) in 43 postmenopausal women with spinal fractures. Furthermore, histomorphometric indices of bone resorption and bone formation, as well as whole body retention (WBR) of 99m-technetium-diphosphonate (99mTc-DP), were determined. The results are compared to pre- and postmenopausal normal subjects. The results showed that indices of bone formation were mutually correlated except for sAP vs. WBR. sAP, WBR, and pBGP increased with age. sAP and WBR were not different between osteoporotics and age-matched controls, while pBGP and probably histological indices of bone formation were lower in osteoporotics than in age-matched controls. pBGP--and to a lesser extent sAP--were significantly correlated with all histological parameters reflecting bone formation. Finally, biochemical indices of bone resorption were high in osteoporotic patients and poorly correlated with histological bone resorption. The discrepancy between biochemical markers of bone formation may be related to the low sensitivity of sAP and WBR. Conversely, pBGP, sAP, and WBR may reflect different aspects of osteoblastic activity and bone mineralization. Finally, our data suggest that bone turnover increases with aging and that osteoporotic patients have higher bone resorption and probably lower bone formation than age-matched controls.

Repetitive natriuresis and blood pressure. Long-term calcium entry blockade with isradipine

The long-term effects (3.5 months) of a new calcium entry blocker of the 1-4-dihydropyridine class, isradipine (PN 200-110), on renal hemodynamics and excretional parameters were investigated in 10 essential hypertensive subjects (World Health Organization Classes I and II). Blood pressure and renal vascular resistance fell significantly (p less than 0.001), and a slight increase in glomerular filtration rate and renal plasma flow was seen (p less than 0.05). Output of fluid from the proximal tubules, measured as clearance of lithium and uric acid, increased significantly (p less than 0.01 and p less than 0.05, respectively), and a compensatory increase in absolute reabsorption of sodium beyond the proximal tubular level accompanied by an increase in clearance of potassium was noted. A 40% increase in the resultant clearance of sodium (p less than 0.01) and an increase in diuresis (p less than 0.05) followed the morning dose of isradipine after 3.5 months of treatment. Changes in blood pressure were significantly correlated with changes in absolute proximal reabsorption of sodium (r = 0.81), excretion of sodium (r = -0.64), and diuresis (r = -0.80). Thus, the natriuretic properties of calcium entry blockers may be more important for the long-term antihypertensive effect than the vasodilator effect per se. A model for renal sodium handling following treatment with calcium entry blockers was proposed. Although a causal relationship is not implied, isradipine induced a sustained, repetitive postdose effect on proximal fluid output, net natriuresis, and diuresis, that was intimately related to the long-term blood pressure-regulating response.

Relationship between plasma renin activity and distal nephron sodium delivery and reabsorption in man

The relationship between plasma renin activity and distal tubular sodium delivery and reabsorption was examined in man. Distal sodium delivery and reabsorption were measured during hypotonic volume expansion by the free water clearance method, or during hydropenia or isotonic volume expansion by the lithium clearance method. The maximal water diuresis method and the lithium clearance method both showed a negative correlation between plasma renin activity and distal sodium delivery and reabsorption. Only with the lithium clearance method, however, was it possible to measure plasma renin activity, distal sodium delivery and reabsorption in hydropenia without disturbances of water and electrolyte balance and plasma renin activity level. In hydropenia the plasma renin activity was higher and the fractional distal sodium delivery and reabsorption lower than during volume expansion. Our results support the idea that sodium chloride reabsorption at the macula densa region is negatively correlated to the plasma renin activity in man.

Lymphomatoid papulosis. A follow-up study of 30 patients

Thirty patients, 13 female and 17 male, have been followed from 3 months to 22 years (mean, 81 months; median, 63 months) and special studies have been performed on a proportion of these in order to try to predict malignant evolution. Age at onset was from 20 to 70 years (mean, 43 years; median, 42 years). Duration of disease was from 1 to 30 years (mean, 119 months; median 161 months). Seven patients also had parapsoriasis en plaque or plaque-stage mycosis fungoides at the time of diagnosis and one patient had erythroderma. None of the 22 uncomplicated lymphomatoid papulosis patients developed malignant cutaneous lymphoma during the period of observation, while the remaining 8 patients who had concurrent parapsoriasis en plaque, mycosis fungoides, or erythroderma did not deteriorate further. Single-cell deoxyribonucleic acid (DNA) measurements on the dermal infiltrate were done in 13 patients and were abnormal in 7 patients. Two of these had greatly abnormal DNA histograms and at the same time an abnormal clinical presentation with multiple nodules and tumors. The remaining five patients had DNA histograms that indicated a potential for malignancy. Monoclonal antibody studies were performed on skin biopsy specimens of 10 patients. The dermal infiltrate was dominated by T-helper lymphocytes and some Hodgkin and Reed-Sternberg cells could be detected by the antibodies Ki-1, Ki-24, and Ki-27. Human T-lymphotropic virus type I (HTLV-I) antibodies were found in 3 of 18 patients examined. Treatment with psoralens plus ultraviolet A (PUVA) was effective (partial or complete remission) in six patients but they relapsed at cessation of therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of a sodium-poor diet on lithium clearance at different dietary potassium contents in rats

In rats on a diet with a sodium content of 300 mmol/kg, lithium is reabsorbed exclusively in the proximal tubules, and lithium clearance (CLi) equals the proximal tubular fluid output (Vprox). In rats on a sodium-poor diet (5 mmol/kg), lithium is also reabsorbed in the distal nephron and CLi is therefore lower than Vprox. The present paper examines the reduction of CLi in response to a low sodium diet in Brattleboro rats with hereditary diabetes insipidus maintained on different dietary potassium contents. CLi was reduced by about 60 microliter/min./100 g body weight in response to a low sodium diet. The absolute reduction in CLi caused by low sodium diet was unaffected by an increase of CLi provoked by administration of potassium with the diet, and it was unaffected by variations of CLi which occurred spontaneously within each group. CLi was accordingly reduced by a constant absolute value rather than by a constant percentage. The reduction of CLi (60 microliter/min./100 g body weight) was equal to CLi in the group given a potassium-poor diet with a normal sodium content. In the low-sodium and low-potassium group CLi was reduced to almost zero. Using CLi as a measure of Vprox in the rats on a 300 mmol/kg sodium diet it is concluded that the absolute reduction of CLi in response to a sodium-poor diet is 1) unaffected by increase of Vprox produced by administration of potassium with the food,2) unaffected by spontaneous variations of Vprox, and 3) equal to Vprox in rats given a potassium-poor diet.

The natriuretic effect of an acute peroral load of potassium chloride after inhibition of potassium secretion with amiloride or lithium

The ability of the kidneys to excrete potassium after an acute peroral potassium load was studied in rats in which the kidney function was influenced by administration of amiloride or lithium for one month. Water, potassium chloride, or sodium chloride solutions were given by gastric tube immediately before a 2-hour clearance period. The results showed that a load of potassium given by gastric tube leads to an increase of potassium excretion in rats given either no treatment, amiloride, or lithium but the increase was about 50% lower in the lithium group. KCl administration provoked a considerable increase of sodium clearance (CNa) compared with the increase of CNa in the control group. The exaggerated natriuresis was apparently specific for potassium, since a peroral load of sodium chloride led to a more modest increase of CNa, an increase which was significant in control rats only. The increase of CNa in rats given a peroral load of potassium could not be explained by an increase of the proximal tubular fluid output, since the latter as measured by lithium clearance (CLi) remained unaltered. Since CNa/CLi rose considerably, the effect could be ascribed to an inhibition of the fractional distal sodium reabsorption.

Plasma bone Gla protein concentrations in healthy adults. Dependence on sex, age, and glomerular filtration

Plasma bone Gla protein (BGP) was determined by radio-immunoassay in 266 healthy adults, men (n = 132) and women (n = 134), aged 20-79 years. In the women aged 30-69 years, plasma BGP increased significantly with age (r = 0.44, p less than 0.001), and a particularly steep increase was seen from 1.1 +/- 0.5 (mean +/- 1 SD) in the fifth decade to 2.0 +/- 1.4 nmol/l in the seventh decade. In men, aged 30-69 years, no correlation was found between plasma BGP and age (r = -0.07, NS). Plasma bone Gla protein is removed from the circulation mainly by the kidneys and the increased plasma BGP in the women could be caused by decreased renal clearance. The interrelationship was analysed by means of partial correlation. When creatinine clearance was held constant in women, BGP still correlated positively with age (r = 0.40, p less than 0.001), but not with creatinine clearance (r = 0.003, NS) when age was fixed. Plasma BGP was significantly increased above normal in 35 patients with chronic renal failure (10.2 +/- 14.6 nmol/l). Non-linear regression analysis showed that plasma BGP was within the normal range when 24-h creatinine clearance was greater than 30 ml/min, and large increases in plasma BGP did not occur until the 24-h creatinine clearance was below 20 ml/min. We conclude that, in normal subjects and patients with mild to moderate renal failure, plasma elevations of BGP reflect increased bone turnover rather than decreased renal clearance.

A continuous T-cell line from a patient with Sézary syndrome

A continuous cell line, Se-Ax, from a patient with Sézary syndrome has been established. The Se-Ax cell line is IL-2 dependent, requires human serum for permanent growth, and has the following phenotype: CD1-, CD2+, CD3+, CD4-, CD5-, CD8-, CD20-, CD25+; it expresses the T9, T10, and HLA-DR antigens. This cell line reveals multiple chromosome aberrations as seen in the most abundant abnormal clone in peripheral blood. Therefore, it is not unlikely that it derives from tumor cells. A putative cytotoxic cell line derived from the same patient has only weak killer-cell activity against the autologous permanent cell line: this CD8+ cytotoxic cell line has a 14q+ chromosomal marker. The fact that the patient demonstrated no natural killer-cell or activated killer-cell activity against the Se-Ax cell line may in part explain the successful establishment of the continuous cell line from bulk culture.

Bone turnover in postmenopausal women after withdrawal of estrogen/gestagen replacement therapy

Bone turnover before and after withdrawal of estrogen/gestagen treatment was studied in a randomized trial with 110 healthy female volunteers, who had passed a natural menopause 6 months to 3 years before the start of the study. Urinary excretion of intravenously injected 99m-technetium diphosphonate was measured as an index of bone turnover; plasma bone Gla protein and serum alkaline phosphatase were measured as indices of bone formation; and fasting urinary excretion of hydroxyproline and calcium were measured as estimates of bone resorption. During 2 years of hormone treatment, all variables decreased highly significantly (p less than 0.001) to a constant low level. Three months after withdrawal all variables increased highly significantly (p less than 0.001) towards, but not above, pretreatment and placebo levels. We conclude that withdrawal of estrogen/gestagen replacement therapy in postmenopausal women increases bone turnover, but not in excess of pretreatment values. This indicates that bone loss (after withdrawal) is similar to that seen in the placebo group and that a rebound phenomenon is unlikely.

Whole body retention of 99mTc-diphosphonate. Relation to biochemical indices of bone turnover and to total body calcium

Whole body retention (WBR) and urinary excretion (UE) of 99mTc-diphosphonate were determined in 161 healthy adults and the results were compared to accepted biochemical markers of bone turnover. WBR was corrected for total body bone mineral (TBBM) and UE for forearm bone mineral content (BMC). Both uncorrected and corrected retention measurements were highly significantly correlated to the biochemical markers (P less than 0.001), but the r values were low (0.22-0.64). All bone turnover variables demonstrated considerably higher levels of bone turnover in postmenopausal women than in premenopausal women (P less than 0.001), whereas the variables were unchanged with age in men. The correction of WBR for TBBM and UE for BMC increased the validity of the retention methods and the two calculations gave exactly the same results on a group basis, both demonstrating significantly higher bone turnover in women than in men in each age group (P less than 0.05-P less than 0.001). All the turnover variables were measured in a group of perimenopausal women (n = 33). The data clearly demonstrated that bone turnover is menopause dependent, whereas age in itself is of minor significance.

Bone turnover determined by urinary excretion of [99mTc]diphosphonate in the prediction of postmenopausal bone loss

Bone mineral content (BMC) of the forearms was measured in 62 healthy early postmenopausal women every 3 months for 2 years to calculate the rate of bone loss. Furthermore, bone turnover was determined at one year using the urinary excretion (UE) of [99mTc]diphosphonate. UE was assessed as a diagnostic test using BMC changes as the gold standard for bone loss. The predictive value for 'accelerated bone loss' (positive test) was 0.58 and for 'non-accelerated bone loss' (negative test) 0.76. The data do not warrant the use of UE as a screening method for bone loss.

Does calcium supplementation prevent postmenopausal bone loss? A double-blind, controlled clinical study

During a two-year study, we examined the effect of calcium supplementation on postmenopausal bone loss in 43 women in the early postmenopausal period who were assigned to one of three treatment groups: percutaneous 17 beta-estradiol (combined with progesterone during the second year), oral calcium (2000 mg daily), and placebo. All participants were examined every three months. Bone mineral content in the forearm (measured by single-photon absorptiometry) and in the entire body and spine (measured by dual-photon absorptiometry) remained constant in the estrogen-treated group but decreased significantly in the groups receiving calcium and placebo. In the calcium-treated group, we observed a tendency toward a slowed loss of compact bone (in the proximal forearm and total skeleton) as compared with the placebo group, while the rate of loss of trabecular bone (the distal forearm and spine) was the same as in the placebo group. Our preliminary data suggest that calcium supplementation in the dosage we used is not as effective as estrogen therapy for the prevention of early postmenopausal bone loss. Calcium supplementation may have had a minor effect on the loss of cortical bone, but it had no effect on the trabecular bone.

Extracutaneous spreading with fatal outcome of mycosis fungoides in a patient treated with ciclosporin A: a word of caution

A patient with mycosis fungoides in the tumor stage was treated with ciclosporin A orally in daily doses of 5 mg/kg body weight for 5 weeks. Three weeks after cessation of treatment the patient died with dissemination of the cutaneous lymphoma to the lungs, myocardium, liver, pancreas, kidneys, adrenals, and stomach. Treatment with ciclosporin A may have contributed to the death of this patient.

The effect of percutaneous estradiol and natural progesterone on postmenopausal bone loss

The effect of percutaneous estradiol alone and combined with natural progesterone on postmenopausal bone loss was studied. A total of 57 women who had experienced a natural menopause 6 months to 3 years previously entered the study. After an initial examination the women were allocated in a blinded pattern to treatment with 3 mg of percutaneous estradiol or placebo. The code was broken after 1 year of treatment, and the women receiving estradiol continued with a cyclic addition of progesterone, whereas those receiving placebo continued with placebo. The women were examined every 3 months during the 2 years of treatment. Measurement of the bone mineral content in the forearms (single photon absorptiometry) and the spine and total skeleton (dual photon absorptiometry) showed a significant decrease of 5% to 7% in the placebo group during the 2 years of treatment, whereas it remained constant in all bone compartments in the estradiol group. Addition of progesterone did not influence the results. Biochemical estimates of calcium metabolism changed toward a premenopausal level in the estradiol group but remained unchanged in the placebo group. We conclude that percutaneous estradiol is effective as preventive therapy of postmenopausal bone loss and that addition of progesterone does not influence bone or calcium metabolism.