AB0439 COMPARATIVE EFFECTIVENESS OF RAPID AND CONVENTIONAL GLUCOCORTICOID TAPERING REGIMENS IN TREATING PATIENTS WITH PROLIFERATIVE LUPUS NEPHRITIS IN THE REAL WORLD SETTING

Background

Rapid glucocorticoid (GC) tapering is recommended for lupus nephritis (LN) by 2019 EULAR/ERA-EDTA recommendations [1]. However, slower conventional GC tapering regimen is still common in the real world setting, and it is controversial whether a rapid GC tapering regimen is as effective as the conventional regimen.

Objectives

We aimed to compare the renal outcomes between rapid and slower GC tapering regimens in patients with LN.

Methods

We retrospectively surveyed the medical records of 27 patients with proliferative LN (class Ⅲ or Ⅳ) at Kobe City Medical Center General Hospital. These patients were divided into two groups (rapid GC tapering group and conventional GC tapering group) according to GC dosage at month 6. Logistic regression analyses were performed to examine the association of GC tapering regimens with achievement of primary efficacy renal response (PERR) and complete renal response (CRR) which were defined by Furie et al. [2] at month 24.

Results

Twenty-seven patients (19 women and 8 men) with class Ⅲ or Ⅳ LN were included. The mean age was 43 years. The mean eGFR and urine protein-to-creatinine ratio at baseline were 66.7 mL/min/1.73m2 and 3.125 g/gCr, respectively. Concomitant class Ⅴ LN was present in 26.0%. The rapid GC tapering group (PSL≦10 mg/day at month 6) and the conventional GC tapering group (PSL>10 mg/day at month 6) were 11 and 16 patients, respectively. Baseline characteristics were balanced between the two groups except for use of cyclophosphamide or mycophenolate mofetil. Mean urine protein-to-creatinine ratio at month 24 were 0.46 g/gCr in the rapid GC tapering regimen group and 1.08 g/gCr in the conventional GC tapering regimen group (p=0.790). Achievements of PERR and CRR at month 24 were 54.0% and 43.8% in the rapid GC tapering group and 54.5% and 25.0% in the conventional GC tapering group, respectively. After adjustment of cyclophosphamide or mycophenolate mofetil usage and urine protein-to-creatinine ratio at baseline, adjusted odds ratio was 1.52 (95% confidence interval [0.126 to 18.29], p=0.743) and 2.99 (95% confidence interval [0.34 to 28.52], p=0.341), respectively.

Conclusion

Our results suggest rapid GC tapering regimen is as effective as conventional slower tapering regimen for patients with proliferative LN.

References

[1]Fanouriakis A, Kostopoulou M, Cheema K, et al. 2019 Update of the Joint European League Against Rheumatism and European Renal Association-European Dialysis and Transplant Association (EULAR/ERA-EDTA) recommendations for the management of lupus nephritis. Ann Rheum Dis 2020;79:713–723.

[2]Furie R, Rovin BH, Houssiau F, et al. Two-Year, Randomized, Controlled Trial of Belimumab in Lupus Nephritis. N Engl J Med 2020;383:1117–1128.

Table 1.

Baseline patients characteristics.

Rapid GC tapering group(n=11)Conventional GC tapering group(n=16)P valueAge – years41.7 ± 14.743.9 ± 16.20.863Female – no. (%)9 (81.8)10 (62.5)0.405Class Ⅲ LN – no. (%)6 (54.5)7 (43.8)0.704Class Ⅳ LN – no. (%)6 (45.5)9 (56.3)0.704Concomitant Class Ⅴ LN – no. (%)4 (36.4)3 (18.8)0.391Induction therapy (use of CY or MMF) – no. (%)10 (90.9)8 (50.0)0.042Serum creatinine – mg/dL1.15 ± 0.721.14 ± 0.800.882eGFR – mL/min/1.73m265.2 ± 39.067.8 ± 34.50.835UPCR – g/gCr3.29 ± 2.963.01 ± 3.250.604C3 – mg/dL41.1 ± 20.145.0 ± 21.50.639C4 – mg/dL6.8 ± 4.710.1 ± 8.00.346

GC, glucocorticoid; LN, lupus nephritis; UPCR, urine protein-to-creatinine ratio; CY, cyclophosphamide; MMF, mycophenolate mofetil

Disclosure of Interests

None declared

Successful treatment of cerebral large vessel vasculitis in systemic lupus erythematosus with intravenous pulse cyclophosphamide

A 39-year-old woman with a six-year history of systemic lupus erythematosus (SLE) was admitted because of a prolonged high fever, discoid rash, and multiple lymphadenopathies. She also developed pericarditis, and was treated with intravenous methylprednisolone pulse therapy followed by prednisolone 50 mg daily and cyclosporine 100 mg daily. Meanwhile, she had a progressive headache, and a brain MRI revealed right pons infarction, although she did not have any abnormal neurological findings. An MRA revealed obvious irregular narrowing in the basilar, right vertebral and right posterior cerebral artery. There was no evidence of antiphospholipid syndrome. We concluded that the cause of the asymptomatic brain infarction was cerebral large vessel vasculitis associated with neuropsychiatric SLE. Intravenous cyclophosphamide pulse therapy was started, and two months later, we confirmed that the irregular arterial narrowing had markedly ameliorated.

Cerebral large vessel vasculitis in neuropsychiatric SLE is very rare, and a marked amelioration has not been reported to date. Here, we present a rare case of cerebral large vessel vasculitis treated successfully with a clear visual presentation.

[Solid variant of aneurysmal bone cyst; report of a case]

We report a rare case of a solid variant of aneurysmal bone cyst (ABC) of the right 4th rib. A 29-year-old woman was admitted to our hospital for an abnormal shadow on chest X-ray. Chest computed tomography (CT) demonstrated the lesion mass to be located in the area of the right 4th rib. Bone scintigram revealed a hot spot in the right 4th rib. The right 4th rib was resected en bloc with the parietal pleura, and adjacent intercostal muscles via right anterior thoracotomy. Postoperative pathological evaluation was consistent with a solid variant of ABC.

[Thoracoscopic removal of bronchogenic cyst of the posterior mediastinum; report of a case]

A 15-year-old female was admitted to our hospital with an abnormal chest X-ray shadow in the left posterior mediastinum found at health screening. Magnetic resonance imaging (MRI) suggested that the cystic lesion contained a viscous liquid. The lesion was removed using a thoracoscope and diagnosed as bronchogenic cyst. Postoperative pathological evaluation was consistent with the initial diagnosis of bronchogenic cyst. This case illustrates the usefulness of thoracoscopic surgery for diagnosis and extirpation of bronchogenic cyst.

[Tuberculous abscess in the chest wall; report of a case]

A 72-year-old woman was admitted to our hospital with left chest pain. Chest computed tomography (CT) revealed an abscess in the left lateral chest wall. Bacterial examination of needle aspiration biopsy specimen from the chest wall abscess disclosed positive acid-fast bacilli. The size of chest wall abscess increased after initiation of antituberculous therapy with isoniazid, rifampicin, ethambutol hydrochloride and pyrazinamide, and therefore abscess drainage was subsequently performed. The lesion was resected after the abscess had diminished in size.

The HAUSP gene plays an important role in non-small cell lung carcinogenesis through p53-dependent pathways

Herpesvirus-associated ubiquitin-specific protease (HAUSP) directly stabilizes the tumour suppressor p53 by de-ubiquitination. Therefore, the HAUSP gene might play an important role in carcinogenesis. In this paper, HAUSP expression and p53 gene status have been studied in relation to the expression of p53 target genes in 131 patients with non-small cell lung cancer (NSCLC). p53 gene status was evaluated by polymerase chain reaction-single-strand conformation polymorphism (PCR-SSCP) followed by sequencing. Quantitative reverse-transcription polymerase chain reaction (RT-PCR) was performed to evaluate the gene expression of HAUSP, p21, and bax. Immunohistochemistry was performed to evaluate the protein expression of p53, HAUSP, mdm2, p21, and bax. Fifty-nine carcinomas (45.0%) showed reduced expression of HAUSP, and 58 carcinomas (44.3%) had mutations of p53. Concerning tumour histology, HAUSP mRNA expression was significantly lower in adenocarcinomas than in squamous cell carcinomas (p = 0.0038), while the frequency of p53 mutation was significantly higher in squamous cell carcinomas than in adenocarcinomas (p = 0.0461). There was no significant difference in HAUSP mRNA expression according to p53 gene status. In total, 93 carcinomas (71.0%) showed either mutant p53 or reduced HAUSP expression. The down-regulation of HAUSP was associated with reduced p53 protein expression (p = 0.0593 in tumours with wild-type p53 and p = 0.0004 in tumours with mutant p53). Furthermore, p21 and bax protein expression was significantly lower in tumours with either mutant p53 or reduced HAUSP expression than in tumours with both wild-type p53 and positive HAUSP expression (p = 0.0440 and p = 0.0046, respectively). In addition, the simultaneous evaluation of both HAUSP expression and p53 gene status was a significant indicator of poor prognosis in adenocarcinoma patients (hazard ratio 4.840, p = 0.0357). These results suggest that reduction of HAUSP gene expression may play an important role in NSCLC carcinogenesis, especially in adenocarcinomas, through p53-dependent pathways.

Congenital sinus of the upper lip with idiopathic precocious puberty

An extremely rare case of congenital sinus of the upper lip is presented in a 22-year-old woman with idiopathic precocious puberty. The sinus has a pin-like orifice located in the midline of the upper lip philtum just below the base of the columella. Sexual precocity was found out when she was 7 years old. A series of exact examinations had been performed at that time. Neither neurogenic lesions of the central nervous system nor other systemic abnormalities were observed. Oral Diseases

[An autopsy case of MPO-ANCA-positive microscopic polyangiitis with manifestations of pulmonary hemorrhage and diffuse alveolar damage]

A 68-year-old woman was admitted to our hospital because of fever of unknown origin and pain in the lower extremities. Six weeks after onset, diffuse infiltrative shadows were observed on chest X-ray films, and marked hypoxemia and progressive renal dysfunction suddenly developed. Corticosteroid therapy (2 courses of pulse therapy, each consisting of methylprednisolone at 500 mg/day for 3 days) was not effective, and the patient died 9 weeks after onset because of respiratory failure. Serologic tests were positive for MPO-ANCA. Histopathologic findings at autopsy disclosed arteriolar fibrinoid necrosis in tissues of the liver, spleen, lungs, and kidneys, thus yielding a diagnosis of microscopic polyangiitis. Lung specimens also demonstrated massive alveolar hemorrhaging in the mid-lung fields and diffuse alveolar damage (DAD) in all lobes. Pulmonary hemorrhage coexistent with DAD worsens the prognosis for microscopic polyangiitis in patients positive for MPO-ANCA.

Immunohistochemical study of fibroblast growth factor-2 (FGF-2) and fibroblast growth factor receptor (FGF-R) in experimental squamous cell carcinoma of rat submandibular gland

Fibroblast growth factor-2 (FGF-2) is a member of the heparin-binding growth factor family and has mitogenic activity. Immunohistochemical expression of FGF-2 and its receptor (FGFR) was evaluated in experimentally induced squamous cell carcinoma as well as transforming cells of rat submandibular gland (SMG) induced by 9,10-dimethyl-1,2-benzanthracene (DMBA)/sponge implantation. Proliferating cells detected by proliferating cell nuclear antigen (PCNA) staining during carcinogenesis were also compared with FGF-2 and FGFR stainings. In the normal SMG, FGF-2 and FGFR were present in the excretory, striated and intercalated duct cells. Pillar and transition cells of granular convoluted tubule (GCT) showed FGF-2 staining, PCNA-labeled cells in normal SMG were rarely observed. In 2-3 weeks after carcinogen implantation, the reactions of FGF-2 and FGFR were expressed in epithelial islands, duct-like structures and affected ductal segments. PCNA-positive cells were developed in these epithelial structures. In 4-8 weeks after carcinogen implantation squamous epithelium appeared surrounding DMBA/sponge and gradually transforming with high PCNA labeling in the based cells and strong staining of FGF-2 and FGFR. Squamous cell carcinoma arose within about 12 weeks of the experiment. In squamous cell carcinoma, there was an intense immunohistochemical expression of FGF-2 and FGFR. Basal and parabasal layers of the squamous cell carcinoma showed high PCNA labeling. FGF-2-positive cells were found in the connective tissue stroma and in inflammatory cells around the proliferating duct-like structure. Coexpression of FGF-2 and FGFR was indicated in transforming cells during carcinogenic processes and in experimental squamous cell carcinoma of rat SMG. These findings suggested that FGF may play an important role for squamous metaplasia and carcinogenesis in rat SMG as an autocrine factor and FGF-positive stromal cells may also act to stimulate epithelial proliferation.

[Treatment of multi drug resistant tuberculosis]

Multi drug resistant pulmonary Tuberculosis (MDR-TB) are divided into two types. The one is primary drug resistance and the other is acquired drug resistance. Cases of acquired MDR-TB are more often. Chemotherapy of MDR-TB demands use in combination of three or more sensitive anti-tuberculosis drugs, but it is difficult to apply this combined treatment practically. In Japan, it is often effective to use in combination of sensitive anti-tuberculosis drugs added PZA, Newquinolon agents and Clarithromycin. When chemotherapy is not effective, surgical treatment should be performed. We experienced six operation cases of MDR-TB. Lobectomy were performed in five cases, and all cases were negative tuberculous bacilli after operation. One case of thoracic empyema with bronchial fistula was positive tuberculous bacilli after operation and died of MDR tuberculosis.

The influence of the great Hanshin earthquake on human response to environmental vibration due to the Shinkansen

A severe earthquake of magnitude 7.2 hit the west part of Japan on January 17, 1995. A part of the Shinkansen railway, which is one of the most popular high-speed mass transportation systems in Japan, was seriously damaged by the earthquake. About 80 days later, the Shinkansen service was resumed but complaints about vibration due to the passing Shinkansen increased rapidly among residents near the tracks. This paper reports the results of two investigations that were carried out in both stricken and non-stricken areas to determine the cause of complaint. In the first investigation, the ground vibration propagation induced by passing trains was measured. In the second investigation, questionnaires were distributed to the people living near the Shinkansen tracks. As a result, it was found out that the vibration levels before and after the earthquake were almost the same at most measured points in the stricken area. It was also found that the vibration levels in the stricken area and a non-stricken area were almost the same within 50 m from the Shinkansen tracks. However the results of the questionnaire survey showed that people's nuisance due to the vibration in the stricken area was clearly greater than that in the non-stricken area. This inconsistency was explained using the "category judgment method", which is generally used to determine the relationship between a physical stimulus and psychological reaction. According to the results of this analysis, the vibration level, at which 50% of the inhabitants complained about Shinkansen vibration, was approximately 54 dB in the non-stricken area and 50 dB in the stricken area. This result suggests that the people who experienced the severe earthquake became 4 dB more sensitive to the Shinkansen vibration than the people living in a non-stricken area despite the fact that this investigation was carried out 10 months after the earthquake struck.

Growth pattern of experimental squamous cell carcinoma in rat submandibular glands--an immunohistochemical evaluation

Histopathological and immunohistochemical studies during carcinogenesis in rat submandibular glands (SMGs) using a carcinogen (9,10-dimethyl-1,2-benzanthracene: DMBA) were evaluated. For carcinogenesis, the carcinogen-containing sponge was surgically inserted into the gland. Histopathological features during carcinogenesis were as follows; dilatation of ductal segments, the presence of duct-like structures and cystic lesion around the sponge were observed within 3 weeks of the experiment, squamous metaplasia in duct-like structures and lining epithelium of the cystic structures around the sponge were observed at 4-6 weeks of the experiment, and finally well differentiated squamous cell carcinomas (SCCs) were observed after 8 weeks of the experiment. The immunoreactivity of K8.12 keration (K8.12), S-100 protein (S-100), epidermal growth factor (EGF), laminin, and proliferating cell nuclear antigen (PCNA) were evaluated. In the normal SMG, EGF was confined to the granular cells and S-100 to the pillar cells of granular convoluted tubules (GCTs). K8.12 was found in striated (SD) and excretory duct (ED) cells and laminin showed linear staining of the basement membrane around the ducts, acini and blood vessels. PCNA-positive nuclei were rarely observed in the normal glandular parenchyma. During carcinogenesis, during the first stage, EGF in granular cells and S-100 in pillar cells of GCT segments disappeared, and cytokeration K8.12 was observed in duct-like structures and cystic epithelium around the DMBA sponge. PCNA-positive nuclei in the first stage were mainly confined to basal cells of morphologically altered ducts. During the second stage, squamous metaplastic cells showed an intense K8.12 reaction. During the third stage, the well differentiated SCC showed strong reaction for K8.12, and the linear staining for laminin staining had disappeared at the invading fronts. The PCNA index was nearly 40% in the tumour cell component. The stem cells or the progenitor cells during experimental carcinoma were most likely to be the ductal basal cells, and carcinogenesis was initiated with an increase of proliferating activity in small cell clusters surrounding a necrotic area, basal cells of dilated excretory ducts and duct-like structures. Thus, all ductal segments undergoing squamous metaplasia may participate in the genesis of neoplasia during experimental carcinogenesis.

Tenascin: growth and adhesion modulation--extracellular matrix degrading function: an in vitro study

Tenascin (TN), a recently characterised extracellular matrix protein, largely confined to the process with the development of embryo in areas of epithelial-mesenchymal interactions and in areas where there are morphogenetic movements and tissue patterning, has a highly restricted expression in adult tissues. The expression of TN is enhanced in a variety of human neoplastic lesions. However, function(s) and molecular mechanisms of enhanced expression in neoplastic lesions remain unclear. We employed human tongue carcinoma cells (SCCKN), human salivary gland adenocarcinoma cells (SGT-1), normal mouse embryonic fibroblasts (NIH3T3-3) and K-ras-2 transformed fibroblasts (Cle-H3) in an in vitro study to elucidate the biological roles of TN. In in vitro studies, all the cell lines examined had enhanced secretion of TN in the presence of transforming growth factor-beta in a dose-dependent manner and TN itself was found to possess a growth-enhancing activity. Moreover, studies on adhesion of the cell lines on coated substrates of fibronectin (FN), laminin (LN), tenascin (TN), TN/FN and TN/LN showed that all the cells adhere and spread well on FN and LN. However, on TN they attach poorly and remain rounded. The relative concentrations of TN and FN affected the cellular adhesion and morphology. In SCCKN and SGT-1, but not in NIH3T3 and Cle-He3 fibroblasts, a higher concentration of TN inhibited cellular adhesion on fibronectin, suggesting that cells attach poorly on TN, it may interfere with the action of fibronectin, and the relative concentrations of TN, FN or LN may affect cellular adhesion and morphology which may differ in different cell types. When TN was added in the growth medium of exponentially growing cells, the cells lost their cell to cell contact and were seen to be separating. The presence of these extracellular matrix proteins were further tested to determine whether they could modulate the secretion of proteolytic enzymes responsible for extracellular matrix degradation by tumour cells, when the neoplastic cells but not the non-neoplastic cells grown on FN/TN substrate showed positive immunofluorescence for collagenase. FN, LN or TN alone did not induce collagenase in the tumour cells. If the same is true in vivo, although a number of factors and interactions may implicate the ultimate outcome, the enhanced expression of TN in neoplastic lesions may have potential implications for tumour growth, differentiation, cellular adhesion, invasion and metastasis.

[A case of acute eosinophilic pneumonia: bronchoalveolar lavage findings before and after steroid treatment]

An 18-year-old woman presented with coughing, fever, progressive dyspnea, and diffuse infiltrates on the chest X-ray film. Analysis of bronchoalveolar lavage fluid showed 73% eosinophils. Acute eosinophilic pneumonia was diagnosed. Methylprenisolone, 1 g per day was given for three days and her condition improved dramatically. No relapse was observed. Analysis of bronchoalveolar lavage fluid also showed lymphocytosis, abnormally high concentrations of ECP, GM-CSF, IL-5 and sICAM-1, and hypersegmentation of eosinophil nuclei. After steroid treatment almost all these findings returned to normal; only lymphocytosis remained. Precipitating antibodies against four kinds of fungi, including Trichoderma viridae, were noted in the serum, but the environmental provocation test was negative and those fungi were not detected in the environmental culture growth. Comparison of bronchoalveolar lavage findings obtained before and after steroid treatment can provide information on the mechanism of eosinophil accumulation in the lung. This case also draws attention to the relationship between acute and chronic eosinophilic pneumonia.

The heparin binding site of follistatin is involved in its interaction with activin

Whether the heparin-binding site of follistatin would interact with activin has been examined. When a mixture of recombinant human follistatin-288 (rhFS-288) and -315 (rhFS-315) was applied to an activin-coupled affinity column, followed by stepwise elution of the column using 4M urea, 8M urea, 1M guanidine-HCl and 2M guanidine-HCl, rhFS-315 was eluted with 4M urea, while rhFS-288 was eluted with 2M guanidine-HCl. This finding implies that the carboxylterminal 27 amino acid extension of rhFS-315, which is not present in rhFS-288, affects the binding of follistatin with activin. Addition of heparin (50 micrograms/ml) to the elution solvent caused rhFS-288 to elute with 4M urea, whereas rhFS-315 was not affected. These data suggest for the first time that these two structurally related follistatin molecules interact with activin by different modes of binding and, in the presence of heparin, the interaction of rhFS-288 with activin is indistinguishable from that of rhFS-315. Two analogs of rhFS-288 mutated at the heparin binding site were eluted with 8M urea or 1M guanidine-HCl, distinct from the elution profile of the intact rhFS-288. These results indicated that mutation at the heparin binding site alters the activin binding affinity. In addition, bioassay of the two mutants showed that they were less potent than the rhFS-288. These findings suggest that the heparin binding site of follistatin also contributes to its binding for activin, and heparin may play an important role in the bioactivity of follistatin.

Immunoreactive tenascin in tumours of salivary glands: evidence for enhanced expression in tumour stroma and production by tumour cells

Tenascin, a large molecular weight extracellular glycoprotein expressed at the epithelial-mesenchymal interface during morphogenesis in embryo, wound healing and in the stroma of various benign and malignant tumours was evaluated in a series of primary epithelial tumours of salivary glands using a monoclonal antibody. Normal salivary glands (n = 5) had linear delicate band-like immunoreactive tenascin in relatively large excretory or intralobular ducts. Pleomorphic adenomas (n = 40) had heterogeneity of expression in modified myoepithelial cell-associated myxoid, hyaline and chondroid areas. Warthin's tumours (n = 10) had a linear immunoreactivity profile of tenascin just adjacent to the basal cells of the epithelial tumour component. A heterogeneity of expression with intense to low or negative stromal immunoreactivity was observed in adenoid cystic carcinomas (n = 8), mucoepidermoid carcinomas (n = 8), epithelial-myoepithelial carcinomas (n = 4), polymorphous low-grade carcinomas (n = 3), papillary cystadenocarcinomas (n = 15) and undifferentiated carcinomas (n = 3). In addition, small cystic spaces or lumens of epithelial-lined tubulo-ductal structures in numerous salivary tumours had positive immunoreactivity for tenascin, suggesting its production by the epithelial tumour component. An enhanced expression of tenascin in salivary tumours suggests a role of this protein in the stromal remodelling and tumour growth.

Immunohistochemical evaluation of bone morphogenetic protein (BMP) in mixed tumor of skin

Immunohistochemical reaction of bone morphogenetic protein (BMP) was assessed in 19 cases of skin mixed tumor and 5 cases of skin appendage tumors by using monoclonal antibody raised against BMP. All cases of skin mixed tumor showed positive staining for BMP in modified myoepithelial cells located at the periphery of tubulo-ductal or solid structures, and in plasmacytoid or tumor cells in hyalinous structures. Chondroidally changed cells also showed a strong BMP immunoreactivity. Tumors originating from sweat glands were devoid of BMP immunoreactivity. It is concluded that BMP is synthesized and produced in modified or transformed myoepithelial cells in skin mixed tumor and participates in the process of chondroid changes in the tumor.

Comparison of proliferating cell nuclear antigen index in benign and malignant salivary pleomorphic adenoma

The expression of proliferating cell nuclear antigen (PCNA) was studied in benign and malignant pleomorphic adenomas by using monoclonal antibody to PCNA. Carcinoma in pleomorphic adenoma (n = 8), cell-rich variant (n = 6) and typical pleomorphic adenoma (n = 6) were selected in this study. The PCNA index in carcinoma in pleomorphic adenoma showed a higher index of nuclear staining (mean 22.9%, S.D. 6.2) than in typical pleomorphic adenoma (mean 6.9%, S.D. 3.4) or a cell-rich variant of pleomorphic adenoma (mean 8.8%, S.D. 3.3). A significant difference in PCNA index was found between benign and malignant pleomorphic adenoma (P < 0.05). The present study suggests that PCNA index significantly differs between pleomorphic adenoma and carcinoma in pleomorphic adenoma, but in the prediction of malignant transformation potential it should be combined with routine histopathological examination.

Chronotoxicological effect of methyl mercury in rat submandibular gland. Immunohistochemical changes of r-EGF, S-100 protein and keratin

The effect of toxicity of methyl mercury was investigated in the submandibular gland (SMG) of adult male rats subjected to 12 h light dark cycle (6 a.m. to 6 p.m. light/resting phase; 6 a.m. to 6 p.m. dark/active phase). Two groups of rats received a defined dose of methyl mercury hydroxide at seven different time points during the active (dark) and resting (light) phase over a 24 h period. After 10 d, the rats were killed at 9 a.m. and 9 p.m. in the resting and active phase, respectively. The immunohistochemical distribution pattern of epidermal growth factor (r-EGF), S-100 protein and K8.12 keratin were studied in granular convoluted tubules (GCT). Those rats which received injections during the active phase (6 p.m. to 6 a.m.), showed stronger reactivity for r-EGF; however, the reactivity for S-100 protein was unchanged. On the contrary, in both groups, GCT cells showed intense staining for K8.12 keratin. It is concluded that the detoxification mechanism of mercury appears to be dependent on the chronobiological oscillation pattern of the GCT and their substructures.

Immunoreactivity of proliferating cell nuclear antigen in salivary gland tumours: an assessment of growth potential

Immunoreactivity of proliferating cell nuclear antigen (PCNA) was assessed to evaluate growth potential in surgically resected tissue specimens from 70 cases of benign and malignant salivary gland tumours. Three stage streptavidin-biotin immunoperoxidase immunostaining using monoclonal antibody to PCNA showed a heterogeneity of PCNA index and distribution. In normal salivary gland specimens, PCNA was demonstrated in the nuclei of few ductal and acinar cells. In pleomorphic adenoma a multiple nodular growth pattern was observed with positive immunoreactivity restricted to the nuclei of tubulo-ductal structures. Warthin's tumour had positive nuclei in the outer cuboidal cells of epithelial component and germinal centres of lymphoid tissue. Myoepithelioma and acinic cell carcinoma showed slightly differing values and a statistically significant difference in the value of the index was observed in tumour cell aggregates of the cribiform type of adenoid cystic carcinoma and the solid undifferentiated type and between low/intermediate and high-grade mucoepidermoid tumours. PCNA is a useful marker of tumour cell proliferation; the index correlates with the grade of malignancy in salivary gland tumours.

Chronoimmunohistochemical localization of epidermal growth factor in the submandibular gland of male rats

Chronobiological oscillation was established for epidermal growth factor (r-EGF) in granular convoluted tubule (GCT) cells of the male rat submandibular gland (SMG) using immunohistochemistry. The high amplitude oscillation with a peak at 9 p.m. and low amplitude oscillation during the day time was noted. The distribution pattern of the r-EGF in the GCT segment was time-dependent, as it was seen at 3 p.m. when many cells with r-EGF staining were detectable. The higher reactivity during the activity phase of the rats may correlate with the intracellular biosynthesis of r-EGF required for cell proliferation and maintenance of ductal integrity. The chronobiological oscillation pattern of r-EGF seems to be important for the maintenance of ductal integrity and wound healing.

Nucleotide sequence of a cDNA encoding the chicken receptor protein kinase of the TGF-beta receptor family

We have isolated RPK-2 cDNA from chick embryo cDNA library that encodes a receptor protein kinase of the TGF-beta receptor subfamily. The deduced amino acid sequence reveals the presence of a hydrophobic transmembrane helix and a kinase domain distantly related to type II receptor for TGF-beta. The kinase domain sequence is most similar to RPK-1 identified recently in the chick embryo. Several cysteine residues are contained in the amino-terminal ectodomain, suggesting the protein as a receptor for a peptide growth factor of the TGF-beta family.

A new receptor protein kinase from chick embryo related to type II receptor for TGF-beta

We have isolated cDNA encoding a new member of protein kinase family from chicken embryo cDNA library. The deduced amino acid sequence comprises a cysteine-rich extracellular domain, a single hydrophobic transmembrane domain, and a cytoplasmic serine/threonine kinase domain. Two short inserts are contained in the kinase domain. The primary structure shows that it belongs to the receptor-type serine/threonine kinase subfamily and is most similar to Daf-1. Conserved cysteine residues in the ectodomain suggest the protein as a receptor for a peptide growth factor of TGF-beta family.

[A rare case of allergic granulomatous angitis (Churg Strauss syndrome) with positive anti-glomerular basement membrane (GBM) antibody in serum]

A 33-year-old man with a 6-month history of rhinitis and bronchial asthma was referred to our hospital with polyarthralgia, severe anemia, hypoxemia, mononeuropathy multiplex, and renal insufficiency with hematuria. Marked eosinophilia was observed in his sputum, peripheral blood, and bronchoalveolar lavage fluid (BALF). In addition, his sputum contained many hemosiderin-laden macrophages, indicative of pulmonary hemorrhage. His chest roentgenogram on admission showed diffuse ground grass appearance. High resolution computed tomography (HRCT) demonstrated diffuse high density areas throughout the lung fields and characteristic irregularity and enlargement of the peripheral pulmonary arteries. His general condition rapidly deteriorated, but dramatically improved with oral steroid administration, and his major symptoms disappeared within a few days. Examination of the biopsied lung tissue revealed unequivocal evidence of pulmonary angitis with marked eosinophilic infiltration and perivascular granulomas. Bone marrow biopsy showed hyperplasia of eosinophilic leukocytes in contrast to the low cellularity. Suppression of erythroid hemopoiesis was thought to be the primary cause for his rapidly progressive anemia. Serum anti-GBM antibody titer returned to within the normal range soon after the initiation of steroid therapy.

Comparison of CEA distribution in lesions and tumors of salivary glands as determined with monoclonal and polyclonal antibodies

Immunohistochemical localization of carcinoembryonic antigen (CEA) with conventional antibody to CEA (anti-CEA), nonspecific crossreacting antigen (NCA)-absorbed polyclonal antibody to CEA (NCAa-CEA), and monoclonal antibody to CEA (Mono-CEA) have been compared in obstructive lesions and salivary gland tumors. Normal salivary glands gave strong staining of the luminal borders of acinar cells with anti-CEA, whereas no staining occurred with Mono-CEA. Obstructive lesions showed occasionally marked staining with anti-CEA in some acinar cells, but there was no reaction with Mono-CEA. Of 69 pleomorphic adenomas examined, 34 were positively stained with anti-CEA, 18 with NCAa-CEA and 8 with Mono-CEA along the luminal borders of the tumor cells. The frequency of positive staining of material within tubular lumina was similar with all three immunoreagents. Neoplastic cells were positive with Mono-CEA in only three cases, while eight cases were positive with NCAa-CEA and 11 cases with anti-CEA. In salivary gland tumors true CEA is be found mainly at the border of tumor cells, but the frequency of positive reactions is low.

Immunohistochemical localization of amylase in sialoadenitis and salivary gland tumors

Immunohistochemical demonstration of alpha-amylase has been made in sialoadenitis-involved tissue and salivary gland tumors, as well as in normal salivary glands. Immunoreactive alpha-amylase with trypsin pretreatment was confined to irregularly staining serous acinar cells in the parotid and submandibular glands, and to demilunes in sublingual glands. In obstructive adenitis, staining was irregular from high to negative in acini in early or intermediate stages. Dilated ductal segments contained cells positive for alpha-amylase in the early stage following obstruction. Pleomorphic adenomas were usually negative for alpha-amylase but in rare cases tumor epithelia stained variably positive; i.e., staining occurred throughout the cytoplasm or at the periphery or apical part of the tumor cells. Luminal cavities of tubular and duct-like structures contained alpha-amylase-positive material. Epithelia in Warthin's tumor were also negative in general; however, scattered single or grouped tumor cells containing alpha-amylase were found. Mucoepidermoid tumors were also negative, though slightly positive cells were found intermingled among the negative squamous and mucous tumor cells. Cystic lesions in mucoepidermoid tumor were sometimes positive in the wall cells together with material secreted into the lumen.

Involucrin expression in epithelial tumors of oral and pharyngeal mucosa and skin

Involucrin has been recognized recently as a marker of terminal differentiation of squamous epithelial cells and also as a useful marker for keratinization; its expression in epithelial tumors of oral and pharyngeal mucosa and skin was examined. Involucrin in normal oral mucosa and skin was restricted to the granular and upper spinous layers and was absent in the basal layer. Hyperkeratosis was characterized by strong positive staining for involucrum in spinous and granular cell layers. A similar pattern was noted in seborrheic keratosis and verruca vulgaris. Condyloma acuminatum specimens revealed slight staining, whereas Paget cells were negative. Calcifying epitheliomas of Malherbe were usually unreactive. Papillomas exhibited the regular distribution of involucrin, as found in normal squamous epithelium. Basal cell carcinomas were generally negative, whereas squamous cell carcinomas showed an irregular distribution of involucrin. Immunohistochemical staining for involucrin may be useful for identification of keratinizing cells in epithelial tumor foci, just as is the use of monoclonal antibody to keratin KL1.

Immunolocalization of keratins in salivary gland pleomorphic adenoma using monoclonal antibodies

Monoclonal antibodies to keratins (KL1 and PKK1) were tested on paraffin sections in forty cases of pleomorphic adenoma from salivary glands. Squamous cells in the epidermis were positive for KL1, except for the basal cells, which were positive for PKK1. In normal salivary glands, ductal cells were positive for KL1 and PKK1 keratins, whereas KL1 staining of the large excretory ducts was weaker than that of PKK1. Myoepithelial cells were positive only for KL1. In pleomorphic adenoma, the following reactions were noted: a positive staining for KL1 and PKK1 was present in the inner layer of cells within tubular and ductlike structures, a markedly positive staining for KL1 was present in squamous metaplastic cells, and a negative staining reaction with KL1 and PKK1 in spindle-shaped tumor cells was observed within the outer layer. Spindle-shaped or fibroblast-like cells in the stroma, probably myoepithelial in origin, showed an irregular staining expression for KL1 and PKK1.

Immunohistochemical observations on carbonic anhydrase I and II in human salivary glands and submandibular obstructive adenitis

Immunohistochemical identification of carbonic anhydrase I and II (CA-I, CA-II) was made in human major salivary glands and obstructive adenitis in submandibular glands. Normal salivary glands stained the strongest for CA-II in serious acinar cells and were negative in mucous cells. Moderate to strong staining for CA-I and CA-II was found in ductal segments. Submandibular glands with obstructive adenitis exhibited reduced CA-I activity in atrophic acinar cells, but not in ductal elements in the early and intermediate stages of the disorder. In the late stage of the obstructive lesion, CA staining in duct-like structures was moderate; however, almost degenerate ductal cells were negative for CA. During the progression of the degeneration in the obstructive lesion, the CA staining decreased dependent on acinar atrophy. Even after longstanding obstruction of the salivary gland, altered ductal epithelia may retain some of their functions.

Immunohistochemical localization of carbonic anhydrase I and II in submandibular salivary glands of the mouse, rat, hamster and guinea pig

Tissues were fixed in Bouin and Carnoy solutions, and the peroxidase, anti-peroxidase (PAP) method was used. Serous acinar cells of the guinea pig were positive for carbonic anhydrase (CA), but acinar cells of rodents were negative. Granular convoluted tubule (GCT) cells of the mouse, rat and hamster had varying degrees of staining for CA isoenzyme I and II. Striated and excretory ducts from all four species were usually positive for CA. Scattered cells containing a high concentration of CA I and CA II were present in striated ducts and GCT of the hamster, GCT of the rat and striated and excretory ducts of the guinea pig.

Distribution difference of lectin binding in salivary gland treated with sialidase and trypsin

Histochemical evaluation of complex carbohydrates in the salivary glands from rodents following sialidase and trypsin treatment were reported by the use of lectins binding technique which specifically link to corresponding sugar residues in macromolecules. Lectin staining in salivary gland generally increased following 1 h sialidase treatment, particularly in guinea-pig specimens. Lectin staining followed by treatment of trypsin (30 min) showed in increase in staining which is characteristic of UEA-I lectin. In long duration treated sections, by either sialidase or trypsin, lectin staining usually decreased in salivary glands. In the present study, complex carbohydrates of salivary glands may be hydrolyzed and degraded by sialidase and trypsin treatments, and lectin binding affinity is then also enhanced due to exposed sugar residues in complex carbohydrates.

Comparison of lectin binding patterns in salivary glands of mice and rats with special reference to different fixatives used

Lectin binding patterns in the salivary glands of mice and rats were compared among specimens treated with 9 kinds of fixatives and then individually subjected to 10 kinds of lectin staining. Formalin-fixed sections showed positive lectin binding with fine granular materials in the GCT cells, and alcohol- or acetone-fixed sections revealed vacuolated patterns of irregular lectin binding with insufficient morphologic detail. Bouin's, Helly's, and Zamboni's fixatives displayed an adequate distribution of lectin binding which corresponded to the histological aspects. Different lectins gave different characteristic binding patterns in SMGs of mice; i.e., PNA and SBA binding was positive in female GCT cells, but absent in the male. On the contrary these lectins gave positive binding in the male acinar cells but negative in the female. These contradictory results were obtained for PNA and SBA binding between the GCT cells and acinar compartments of the mouse SMGs. The GCT and acinar cells in the SMGs of mice and rats also gave contradictory results; i.e., mice GCT cells displayed positive Con A staining but negative PA/Con A staining, whereas mice acinar cells were stained weakly by the Con A and staining strongly by the PA/Con A methods. Rats GCT cells indicated negative Con A, and strong PA/Con A staining; whereas rats acinar cells gave a positive Con A and negative PA/Con A reaction.

Different bindings to lectin in human submandibular gland after enzymatic digestion

Lectin binding affinities were described in human submandibular gland (SMG) in the paraffin sections following alpha-amylase, sialidase, and trypsin digestions. Lectins in the present study were used Con A (Glc, Man binding lectins), PNA, and SBA(Gal, GalNAc), RCA-1(Gal), DBA(GalNAc), WGA(GlcNAc), and UEA-1(Fuc). Lectin stainings in serous and mucous acinar cells and ductal epithelia were reported to compare enzyme treated and nontreated sections. Amylase treatment showed increasing Con A staining in connective tissue fibers and no marked changes in SMG to lectin bindings. Sialidase digestion was characteristically intense in PNA and SBA bindings in SMG cells, and also enhanced staining to UEA-1 in serous and duct cells and to WGA in mucous and duct cells were noted. Trypsin digestion indicated a slight increase to Con A binding, and was relatively strong to UEA-1 in serous and duct cells and a little strong to WGA. The results suggested that SMG serous cells contain higher amounts of Gal, GalNAc, and Fuc residues; and mucous cells were also abundant in Gal, GalNAc, and GlcNAc residues.

False positive reaction for carcinoembryonic antigen in Paget cells. Immunohistochemical observation

Paget cells from cases of mammary and extramammary Paget's disease were examined for carcinoembryonic antigen (CEA) and CEA-related antigens by the immunoperoxidase method. Paget cells showed a conspicuous positive reaction with antiserum to CEA, but were negative when nonspecific cross-reacting-antigen (NCA)-absorbed antiserum to CEA, or a monoclonal antibody to CEA was used as the detecting agents. Paget cells may contain large amounts of NCA antigen or CEA-related substances.

Immunohistochemical observation of EGF and NGF in submandibular glands after duct ligation with or without testosterone administration

Immunohistochemical detection of epidermal growth factor (EGF) and nerve growth factor (NGF) was carried out in duct-ligated submandibular glands (SMG) of mice with or without testosterone treatment. High levels of EGF and NGF were limited to granular convoluted tubule (GCT) cells in normal adult male mice, and reduced levels were evident in the female. After duct ligation, EGF and NGF stainings began to decrease on the 2nd or 3rd day, and by the 10th day, no staining was detectable. Decreasing levels of EGF and NGF following duct ligation, were more pronounced in the male SMG than in the female. Testosterone administration before ligation resulted in decreased EGF and NGF levels of staining; however, staining of sections on the 1st and 3rd day was a little stronger than comparable stained sections of untreated mice. In contrast, testosterone administration after duct ligation showed GCT cells of normal size with some degranulation at 10 days and irregular staining of growth factors with varying degrees of degranulation at 14 days. Histochemical staining for EGF and NGF in this group was marked, as in the normal, until the 10th day with decreasing reactions by the 14th day.