Incidence, clinicopathological features, and clinical outcomes of low HER2 expressed, inoperable, advanced, or recurrent gastric/gastroesophageal junction adenocarcinoma

BACKGROUND

According to the DESTINY-Breast04 trial, treating patients with breast cancer and low human epidermal growth factor receptor 2 expressions (HER2-low) varies from that of those with no HER2 expression. However, it is interesting to know if HER2-low indicates for anti-HER2 therapy in the gastric or gastroesophageal junction (G/GEJ) adenocarcinoma. Hence we conducted this study to assess the incidence, clinicopathological features, and treatment outcomes of patients with HER2-low G/GEJ adenocarcinoma.

PATIENTS AND METHODS

This was a single-center, retrospective observational study. Patients with previously untreated G/GEJ adenocarcinoma were classified based on their HER2 status using immunohistochemistry (IHC) with or without in situ hybridization (ISH) as follows: HER2 negative (IHC 0), HER2-low (IHC 1+ or 2+/ISH-), and HER2-positive (IHC2+/ISH+ or 3+).

RESULTS

In total, 734 patients with G/GEJ adenocarcinoma were divided into three groups (HER2-negative, n = 410; HER2-low, n = 154, and HER2-positive, n = 170). The intestinal-type histology, peritoneal metastasis, and higher serum carcinoembryonic antigen (CEA) levels differed significantly among patients with negative, low, and positive HER2 statuses: intestinal-type histology (21.0%, 44.2%, and 59.8%, respectively), peritoneal metastasis (56.3%, 44.8%, and 21.8%, respectively), and higher serum CEA level (32.2%, 41.6%, and 56.5%, respectively). Improved survival was observed in the HER2-positive group than in the HER2-negative G/GEJ adenocarcinoma group [hazard ratio (HR) = 0.73, 95% confidence interval (CI) 0.59-0.89; P = 0.002]. However, the prognoses of the HER2-low and HER2-negative groups were similar (HR = 1.01, 95% CI 0.82-1.23; P = 0.843).

CONCLUSIONS

Patients with HER2-low G/GEJ adenocarcinoma exhibited intermediate and distinct characteristics than those in the HER2-negative group. Similarly, the HER2-low group's prognosis was worse than that of the HER2-positive group. Therefore developing novel therapeutic strategies targeting HER2-low G/GEJ adenocarcinoma is required.

A Case of Chronic Active Antibody-Mediated Rejection Caused by a Pre-Existing Anti-DQ Donor-Specific Antibody in a Systemic Lupus Erythematosus Recipient Without History of Sensitization: A Case Report

BACKGROUND

Systemic lupus erythematosus (SLE) is reported to produce anti-HLA antibodies. We report a case of chronic active antibody-mediated rejection caused by pre-existing donor-specific antibody (DSA) in a patient with SLE without a history of sensitization.

CASE REPORT

The case was a 29-year-old man with end-stage renal disease due to lupus nephritis. Cross-match with the mother was negative, but low titer anti-DQ DSA was detected, although he had no prior history of sensitization. After desensitization with rituximab and mycophenolate mofetil, a living donor kidney transplant was undergone, and his early postoperative period was uneventful. However, his renal function started to decline at 2 years post-transplant. Although there was no rejection on the biopsy at 2.5 years post-transplant, his renal function continued to decline after that. At 7 years, he had failed his graft due to chronic active antibody-mediated rejection. Retrospective analysis of human leukocyte antigen antibody tests revealed that anti-DQ DSA had disappeared at 1 year post-transplant, but high titer DSA was detected again with complement-binding capacity at 2 years and after that.

CONCLUSION

Careful monitoring might be warranted in an SLE patient with pre-existing DSA, even though the titer was low and without any prior histories of sensitization events.

Impact of in-hospital medical management for COVID-19 pandemic on door-to-balloon time in patients with ST-elevation myocardial infarction

Background

Delayed door-to-balloon (DTB) time and deterioration of in-hospital mortality during the coronavirus disease 2019 (COVID-19) pandemic have been reported. Little is known about the impact of changes in in-hospital medical management before primary percutaneous coronary intervention (PCI) for COVID-19 such as screening test (antigen or polymerase chain reaction (PCR) tests, chest CT for excluding the pneumoniae) and primary PCI under full personal protective equipment (PPE) on DTB time and in-hospital mortality.

Purpose

The purpose of this study was to evaluate the impact of in-hospital medical management for COVID-19 on DTB time and in-hospital mortality during COVID-19 pandemic period.

Methods

We compared DTB time and in-hospital mortality of 502 ST-elevation myocardial infarction (STEMI) patients during COVID-19 pandemic (February 2020 and January 2021) with 2035 STEMI patients before pandemic (February 2016 and January 2020) using date from Mie ACS registry, a retrospective and multicenter registry.

Results

The COVID-19 screening tests before primary PCI and/or primary PCI under full PPE was performed on 173/502 (34.5%) patients (antigen or PCR tests; 39 (7.8%), chest CT; 156 (31.3%), full PPE; 11 (2.2%)). These patients had lower rate of achievement of DTB time ≤90 min compared with others (Figure 1A). Moreover, In-hospital management of COVID-19 screening tests and/or primary PCI under full PPE was an independent factor of DTB time>90 min with odds ratio of 1.94 (95% confidential interval: 1.37–2.76, p<0.001). In addition, in-hospital mortality of those patients was higher compared with others (Figure 1B).

Conclusion

In-hospital medical management for COVID-19 screening tests before primary PCI and/or primary PCI under full PPE was the independent factor of DTB time>90 min. This study reinforces the need to focus efforts on shortening DTB time, while controlling the epidemic of infection.

Funding Acknowledgement

Type of funding sources: None.

Shoseiryuto Ameliorated TDI-Induced Allergic Rhinitis by Suppressing IL-33 Release from Nasal Epithelial Cells

Toluene diisocyanate (TDI) is a major cause of occupational asthma and rhinitis. Shoseiryuto (SST) is one of the traditional herbal medicines (Kampo medicine) and has long been used as a natural medicine for allergic diseases such as allergic rhinitis (AR) and asthma. Recent studies have shown that the expression and release of IL-33, which regulates the T_H2 cytokine response in epithelial cells, is an important step in developing the inflammatory response of the nasal mucosa. In this study, we investigated whether SST may ameliorate the TDI-induced AR-related symptoms in rats and inhibit IL-33 release from nasal epithelial cells. An AR rat model was generated by sensitization and induction with TDI. SST was administered during the sensitization period. AR-related symptoms in rats were evaluated, and IL-33 release was measured both in vivo and in vitro. SST suppressed symptoms appearing in TDI-induced AR model rats, such as elevated serum histamine and IL-33 levels in nasal lavage fluid (NLF)/serum, which were suppressed by SST administration. TDI-induced IL-33 release from the nasal epithelial cell nuclei was also observed and suppressed in SST-treated rats and cultured nasal epithelial cells. These results suggest that SST ameliorates the symptoms of TDI-induced AR at least partially by inhibiting IL-33 release from nasal epithelial cells.

Kampo Formulae for the Treatment of Neuropathic Pain ∼ Especially the Mechanism of Action of Yokukansan ∼

Kampo medicine has been practiced as traditional medicine (TM) in Japan. Kampo medicine uses Kampo formulae that are composed of multiple crude drugs to make Kampo formulae. In Japan, Kampo formulae are commonly used instead of or combined with Western medicines. If drug therapy that follows the guidelines for neuropathic pain does not work or cannot be taken due to side effects, various Kampo formulae are considered as the next line of treatment. Since Kampo formulae are composed of two or more kinds of natural crude drugs, and their extracts contain many ingredients with pharmacological effects, one Kampo formula usually has multiple effects. Therefore, when selecting a formula, we consider symptoms other than pain. This review outlines the Kampo formulae that are frequently used for pain treatment and their crude drugs and the basic usage of each component. In recent years, Yokukansan (YKS) has become one of the most used Kampo formulae for pain treatment with an increasing body of baseline research available. We outline the known and possible mechanisms by which YKS exerts its pharmacologic benefits as an example of Kampo formulae's potency and holistic healing properties.

Whole-Genome Sequencing of the NARO World Rice Core Collection (WRC) as the Basis for Diversity and Association Studies

Genebanks provide access to diverse materials for crop improvement. To utilize and evaluate them effectively, core collections, such as the World Rice Core Collection (WRC) in the Genebank at the National Agriculture and Food Research Organization, have been developed. Because the WRC consists of 69 accessions with a high degree of genetic diversity, it has been used for >300 projects. To allow deeper investigation of existing WRC data and to further promote research using Genebank rice accessions, we performed whole-genome resequencing of these 69 accessions, examining their sequence variation by mapping against the Oryza sativa ssp. japonica Nipponbare genome. We obtained a total of 2,805,329 single nucleotide polymorphisms (SNPs) and 357,639 insertion-deletions. Based on the principal component analysis and population structure analysis of these data, the WRC can be classified into three major groups. We applied TASUKE, a multiple genome browser to visualize the different WRC genome sequences, and classified haplotype groups of genes affecting seed characteristics and heading date. TASUKE thus provides access to WRC genotypes as a tool for reverse genetics. We examined the suitability of the compact WRC population for genome-wide association studies (GWASs). Heading date, affected by a large number of quantitative trait loci (QTLs), was not associated with known genes, but several seed-related phenotypes were associated with known genes. Thus, for QTLs of strong effect, the compact WRC performed well in GWAS. This information enables us to understand genetic diversity in 37,000 rice accessions maintained in the Genebank and to find genes associated with different phenotypes. The sequence data have been deposited in DNA Data Bank of Japan Sequence Read Archive (DRA) (Supplementary Table S1).

P5007Acute natriuretic activity of sodium-glucose cotransporter 2 inhibitor in heart failure patients with type 2 diabetes mellitus

Background

Sodium-glucose cotransporter 2 (SGLT2) inhibitor promotes diuresis and reduces the risk of hospitalization for heart failure (HF). However, the mechanisms of diuretic effects of SGLT2 inhibitor in HF patients with type 2 diabetes mellitus (T2DM) remain under investigation.

Purpose

The purpose of this study was to investigate the mechanisms of acute diuretic effects of SGLT2 inhibitor and to identify its predictor in HF patients with T2DM.

Methods

We prospectively enrolled 40 hospitalized HF patients with T2DM (68±13 years, 63% male, and hemoglobin A1c 7.1±0.9%) between July 2014 and June 2018. All patients received ipragliflozin at a dose of 50 mg once daily after breakfast. They underwent 24-hour urine test and first-morning blood and urine tests before and after ipragliflozin therapy.

Results

Urine volume significantly increased from 1,365±511 ml/day on day 0 to 1,698±595 ml/day on day 3 (p<0.001). Multivariate linear regression analyses showed that the increase of 24-hour urine sodium but not urine sugarwas significantlyand independently associated with the increase of 24-hour urine volume (β-Coefficient=0.80; P<0.001). Univariate and multivariate logistic regression analyses showed that higher dosage of furosemide-equivalent loop diuretics and lower level of first-morning urine sodium concentration (per 1 mEq/L) at baseline were significantly associated with the diuretic effect of ipragliflozin therapy, and the latter independently predicted increase of 24-hour urine volume (Table).

Predictors for increase of urine volume Univariate Multivariate Odds ratio (95% CI) P value Odds ratio (95% CI) P value Dosage of furosemide, mg 1.09 (1.01–1.18) 0.04 – – HbA1c, % 1.45 (0.56–3.78) 0.44 Fasting blood glucose, mg/dL 1.02 (0.99–1.04) 0.24 eGFR, mL/min/1.73m2 1.01 (0.97–1.05) 0.65 Plasma BNP, pg/mL 1.00 (0.99–1.01) 0.12 Left ventricular ejection fraction, % 0.98 (0.94–1.02) 0.24 First-morning urine sugar, mg/dL 1.20 (0.96–1.50) 0.12 First-morning urine sodium, mEq/L 0.96 (0.93–0.99) 0.02 0.96 (0.93–0.99) 0.02 24-hour urine sugar, g/day 3.49 (0.13–93.40) 0.46 24-hour urine sodium, mEq/day 0.98 (0.96–1.01) 0.20 eGFR, estimated glomerular filtration rate; BNP, brain natriuretic peptide.

Conclusion

SGLT2 inhibitor has acute natriuretic activity and may restore loop-diuretic resistance in HF patients with T2DM.

Acknowledgement/Funding

None

Identification of qRBS1, a QTL involved in resistance to bacterial seedling rot in rice

Bacterial seedling rot (BSR), a destructive disease of rice (Oryza sativa L.), is caused by the bacterial pathogen Burkholderia glumae. To identify QTLs for resistance to BSR, we conducted a QTL analysis using chromosome segment substitution lines (CSSLs) derived from a cross between Nona Bokra (resistant) and Koshihikari (susceptible). Comparison of the levels of BSR in the CSSLs and their recurrent parent, Koshihikari, revealed that a region on chromosome 10 was associated with resistance. Further genetic analyses using an F5 population derived from a cross between a resistant CSSL and Koshihikari confirmed that a QTL for BSR resistance was located on the short arm of chromosome 10. The Nona Bokra allele was associated with resistance to BSR. Substitution mapping in the Koshihikari genetic background demonstrated that the QTL, here designated as qRBS1 (quantitative trait locus for RESISTANCE TO BACTERIAL SEEDLING ROT 1), was located in a 393-kb interval (based on the Nipponbare reference genome sequence) defined by simple sequence repeat markers RM24930 and RM24944.

A multiple gene complex on rice chromosome 4 is involved in durable resistance to rice blast

Quantitative trait loci (QTLs) for resistance to rice blast offer a potential source of durable disease resistance in rice. However, few QTLs have been validated in progeny testing, on account of their small phenotypic effects. To understand the genetic basis for QTL-mediated resistance to blast, we dissected a resistance QTL, qBR4-2, using advanced backcross progeny derived from a chromosome segment substitution line in which a 30- to 34-Mb region of chromosome 4 from the resistant cultivar Owarihatamochi was substituted into the genetic background of the highly susceptible Aichiasahi. The analysis resolved qBR4-2 into three loci, designated qBR4-2a, qBR4-2b, and qBR4-2c. The sequences of qBR4-2a and qBR4-2b, which lie 181 kb apart from each other and measure, 113 and 32 kb, respectively, appear to encode proteins with a putative nucleotide-binding site (NBS) and leucine-rich repeats (LRRs). Sequence analysis of the donor allele of qBR4-2a, the region with the largest effect among the three, revealed sequence variations in the NBS-LRR region. The effect of qBR4-2c was smallest among the three, but its combination with the donor alleles of qBR4-2a and qBR4-2b significantly enhanced blast resistance. qBR4-2 comprises three tightly linked QTLs that control blast resistance in a complex manner, and thus gene pyramiding or haplotype selection is the recommended strategy for improving QTL-mediated resistance to blast disease through the use of this chromosomal region.

Thermodynamic investigation of coordination-networked systems of [Mn4] single-molecule magnets under pressure

Low temperature heat capacity measurements under pressure were performed for tiny single crystals of two-dimensional coordination-networked compounds consisting of [Mn(4)] single-molecule magnets (SMMs) by the ac temperature modulation technique. Systematic variations of the peak temperature and the peak width of the thermal anomalies produced by pressure were clearly detected using two ruthenium oxide resistance chips in the Cu-Be clamp-type cell. A linear increase of the Néel temperature for an ordering set of large SMM spins with S=9 was observed in [Mn(4)(hmp)(6){N(CN)(2)}(2)](ClO(4))(2), while a non-monotonic variation of the peak temperatures and peak shapes was observed in [Mn(4)(hmp)(4)Br(2)(OMe)(2){N(CN)(2)}(2)](ClO(4))(2)·2THF·0.5H(2)O (hmp(-)=2-hydroxymethylpyridinate; N(CN)(2)(-)=dicyanamide as the linker among SMMs). We also report on thermodynamic behavior produced by changing external pressures and magnetic fields. The results are discussed in terms of the tilting angle of Ising axes in the two-dimensional plane.

Radiosurgery for arteriovenous malformations with gamma-knife: a multivariate analysis of factors influencing the complete obliteration rate

Seventy-two patients with arteriovenous malformations (AVMs) were treated with gamma-knife and subsequently analyzed to determine what factors influenced the obliteration of AVMs. The volume of nidi ranged from 0.3 to 21.7 ml (mean 3.9 ml) and the marginal dose ranged from 9 to 31.5 Gy (mean 21.4 Gy). The cumulative obliteration rates of all cases were 41% at 2 years, 67% at 3 years, and 89% at 4 years. Multivariate analysis demonstrated that only the two variables of flow rate (P = 0.020) and dose planning with axial MRI (P = 0.045) had correlation with the obliteration rate. Other variables such as size, marginal dose, and embolization had no statistical correlation with the obliteration rate. It may be very important to evaluate the AVM flow rate to predict the effect of gamma-knife radiosurgery on AVMs, even when the nidi volumes are small.

Genetic and physical mapping of the partial resistance gene, pi34, to blast in rice

ABSTRACT Partial resistance to rice blast in the Oryza sativa japonica group cv. Chubu 32 is controlled by Pi34, a major quantitative trait locus (QTL) on chromosome 11, and several uncharacterized QTLs. The objectives of the study were (i) high-resolution genetic and physical mapping of Pi34 and (ii) identification of new QTL imparting resistance to rice blast. Chubu 32 was crossed with a susceptible chromosomal segment substitution line (CSSL) of cv. Koshihikari. From 4,012 of segregating individuals, 213 recombinants in the Pi34 region were screened by using polymerase chain reaction-based markers and tested resistance in the field and greenhouse. The Pi34 locus is located in the 54.1-kb region on the genomic sequence of cv. Nipponbare. We constructed a bacterial artificial chromosome (BAC) library of Chubu 32, selected the clone containing Pi34, and sequenced it. The Pi34 locus consequently was located on an interval of 65.3 kb containing 10 predicted open reading frames (ORFs). Two of these ORFs were predicted only in Chubu 32 and encoded transposable elements. The other eight ORFs were found in both Chubu 32 and Nipponbare and one of them, which encoded an unknown protein, showed significantly different amino acid sequences between two cultivars. The new QTL, Piq6(t), was detected on the short arm of chromosome 6 and the genetic distance of flanking markers was 16.9 centimorgans in Nipponbare. Pi34 and Piq6(t) acted additively on resistance to rice blast but the effect of Piq6(t) was relatively small compared with Pi34.

GP2/THP gene family of self-binding, GPI-anchored proteins forms a cluster at chromosome 7F1 region in mouse genome

We investigated the genomic organization of pancreatic zymogen granule membrane-associated protein GP2, a GPI-anchored protein exhibiting self-aggregation at acidic pH, in order to construct a gene-knockout mouse. Cloning and analysis of lambda clones encoding GP2 from 129 Svj mouse genomic DNA libraries showed that the GP2 gene spans about 16.8 kb and includes 11 exons. Identifiable functional domains including a signal sequence, an EGF-like motif, a putative condensing ZP domain, a GPI-anchor attachment site, and a transmembrane sequence for GPI anchoring are encoded in separate exons. Using FISH, the GP2 gene was mapped to mouse chromosome 7F1 near the gene for THP, a GP2 homolog expressed in the cells of thick ascending loop of Henle (TALH) in the kidney. Further analysis of the mouse genome revealed that the THP and GP2 genes are adjacent to one another and are separated by only 3.5 kb in the 7F1 locus. Additionally, the overall structure of the THP gene, 16.2kb with 11 exons, was strikingly similar to that of GP2. This finding suggests that the GP2 and THP genes were generated by gene duplication and evolved separately to acquire regulatory elements leading to tissue-specific expression. Comparative analysis revealed that the 5' flanking region of the THP gene is similar to the first intron of NKCC2, a TALH cell-specific ion-transporter gene. The promoter region of the GP2 gene shares cis-elements found in other pancreas-specific genes. Using this genetic information, a GP2 null mutation was successfully introduced into an ES cell line, and an animal model was established without disruption of THP expression.

Development of cholinergic chronotropic control in chick (Gallus gallus domesticus) embryos

In chick (Gallus gallus domesticus) embryos, instantaneous heart rate begins to fluctuate with the appearance of rapid, transient decelerations at around the end of the second week of incubation. Previously, it was shown that instantaneous heart rate decelerations were eliminated by administration of atropine and concurrently heart rate baseline was elevated in late embryos. Because the previous study lacked statistical treatment and there has been recent controversy over the development of tonic vagal control of the heart, we reexamine the hypothesis that transient decelerations of instantaneous heart rate are mediated by vagus nerve and the vagal tone begins to appear at around the end of the second week of incubation. Atropine administration tests were conducted for sixty-seven 11- to 14-day-old and 18-day-old embryos in total. Heart rate decelerations appeared sporadically in three out of ten 12-day-old embryos, but the difference of mode heart rate before and after administration of atropine was not significant. Seven out of nine 13-day-old embryos and all nine 14-day-old embryos showed heart rate decelerations and the difference of mode heart rate before and after atropine administration was significant. In late (18-day-old) embryos, magnitude and frequency of instantaneous heart rate decelerations further increased with additional appearance of transient, irregular accelerations. Administration of varying doses of atropine completely eliminated the heart rate decelerations and elevated the heart rate baseline more markedly than in young embryos, indicating the maturation of vagal tone late in incubation.

Gamma knife radiosurgery for growth hormone-secreting pituitary adenomas invading the cavernous sinus

The authors assessed whether gamma knife radiosurgery is effective for patients with acromegaly where the pituitary tumors invaded the cavernous sinus. Radiosurgery was performed on 9 patients (average of 20 Gy to the tumor margin), 8 of whom had already undergone transsphenoidal surgery and/or craniotomy with occasional medication of octreotide to reduce tumor size as well as hormonal levels. All tumors have been well controlled so far with follow-up periods ranging from 12 to 69 months (mean: 42). No complications occurred. Forty percent of the patients showed hormonal normalization at 2 years, with the median being 31 months. Similarly, 50% of the patients demonstrated normalization of GH and IGF-I at 36 months. We conclude that gamma knife radiosurgery is a safe and effective tool to treat these tumors invading the cavernous sinus.

A new extraction method for Acinetobacter species ODB-L2 rough form lipopolysaccharide from culture broth

The Gram-negative bacterium Acinetobacter species ODB-L2 produces lipopolysaccharide (LPS) in culture broth. The LPS could not be purified by conventional extraction methods using 90% phenol/water or 90% phenol/chloroform/petroleum ether mixed solvent. Extraction was achieved employing an admixture of chloroform, ethanol, and 4 M HCI solution. The LPS was purified from dissolving the crude extracts in 90% phenol and LPS sediment formed by addition of methanol. The LPS was characterized by chemical, biochemical, and physicochemical methods as rough form 3-hydroxydodecanoic acid rich LPS.

Feasibility of myocardial dual-isotope perfusion imaging combined with gated single photon emission tomography for assessing coronary artery disease

The clinical feasibility of both dual-isotope single photon emission tomography (SPET) and gated SPET have been described. The present study evaluates the feasibility of combining gated SPET with exercise 201Tl/rest 99mTc-tetrofosmin dual-isotope SPET corrected for scatter. Ninety-one patients with known or suspected coronary artery disease underwent cardiac catheterization and coronary angiography. Twenty-nine of them underwent exercise 201Tl/rest 99mTc-tetrofosmin dual-isotope SPET with a second 201Tl injection 3 h after the initial 201Tl injection (protocol 1). We then segregated a Bull's eye polar map into three coronary artery territories and quantified the relative regional uptake. The remaining 62 patients underwent exercise 201Tl/rest 99mTc-tetrofosmin dual-isotope SPET combined with gated SPET. We visually evaluated exercise and rest images from the three coronary artery territories. Left ventricular (LV) function was assessed globally by means of the LV ejection fraction and regionally by means of visual scoring analysis, compared with left ventriculography (LVG). The correlation between rest 99mTc-tetrofosmin and 201Tl reinjection images in 87 areas of coronary artery territory (r=0.89, P<0.01) and in 13 infarcted areas (r =0.94, P<0.01) was very close in protocol 1. The overall values for vessel-related sensitivity, specificity and accuracy were 88%, 79% and 82%, respectively, in protocol 2. The correlation between gated SPET and LVG was significant and linear with respect to the LV ejection fraction (r=0.77, P<0.01). The wall motion score from visual evaluation in gated SPET revealed a close overall agreement with LVG (concordance rate, 88%; kappa, 0.670). Exercise 201Tl/rest 99mTc-tetrofosmin dual-isotope SPET with scatter correction for assessing the coronary artery disease offers excellent diagnostic accuracy and the additional gated SPET provides useful information about LV function similar to that for LVG. This sequential protocol requires only 2 h to generate much useful clinical information.

Analysis of the C-terminal structure of urinary Tamm-Horsfall protein reveals that the release of the glycosyl phosphatidylinositol-anchored counterpart from the kidney occurs by phenylalanine-specific proteolysis

Tamm-Horsfall protein (THP), also known as uromodulin, is a major glycoprotein synthesized in the kidney. THP is expressed on the luminal surface of the membrane with the glycosyl phosphatidylinositol (GPI) anchor and excreted in urine at a rate of 50-100 mg per day. Although THP is the most abundant urinary protein, the function of THP remains unclear. In addition, little is known about the mechanism by which large amounts of THP are actively released into the urinary fluid. In this study, we examined the C-terminal structure of highly purified THP derived from human urine. Carboxypeptidase Y efficiently degraded urinary THP, indicating that the C-terminal structure of the protein contains an amino acid residue with a free carboxyl moiety. These results are consistent with our previous finding that urinary THP does not bind anti-CRD antibody. We obtained peptides from the complete digestion of urinary THP with lysylendopeptidase. We purified the most C-terminal peptide with p-phenylene diisothiocyanate-controlled pore glass (DITC-CPG) beads. N-terminal sequence analysis indicated the peptide begins with Tyr 520 and ends between E539 and E576. Direct C-terminal amino acid sequencing of highly purified urinary THP gave a sequence of -X-(Q)-G-(R)-F, corresponding to amino acids 544-548, -S-Q-G-R-F. We therefore conclude that urinary THP is generated by a proteolytic cleavage between F548 and S549, 66 amino acids upstream of a possible GPI-anchor attachment site. Because the sequence of THP, including the cleavage site, is highly homologous to that of GP2, a GPI-anchored protein within the pancreas, and both THP and GP2 are abundantly found as soluble forms in the excreted fluids, a common mechanism may exist governing the proteolytic release of GPI-anchored membrane proteins.

Acute necrotizing eosinophilic myocarditis successfully treated by high dose methylprednisolone

Acute necrotizing eosinophilic myocarditis is the most severe form of eosinophilic myocarditis, or hypersensitivity myocarditis, and is characterized by rapidly progressive congestive heart failure followed by fulminant clinical deterioration that is nearly always fatal. A 55-year-old previously healthy patient with acute necrotizing eosinophilic myocarditis was diagnosed by early myocardial biopsy and successfully treated with corticosteroids. Throughout his hospitalization, the eosinophil count in the peripheral blood remained normal (56-201/mm3). Early stage corticosteroid therapy can have dramatic effects in acute necrotizing eosinophilic myocarditis and early diagnosis by endomyocardial biopsy is recommended.

Biophysical characterization of lipopolysaccharide and lipid A inactivation by lactoferrin

The interaction of bacterial endotoxins (LPS Re and lipid A, the 'endotoxic principle' of LPS) with the endogenous antibiotic lactoferrin (LF) was investigated using various physical techniques and biological assays. By applying Fourier-transform infrared (FTIR) spectroscopy, we find that LF binds to the phosphate group within the lipid A part and induces a rigidification of the acyl chains of LPS. The secondary structure of the protein - as monitored by the amide I band - is, however, not changed. Concomitant with the IR data, scanning calorimetric data indicate a sharpening of the acyl chain phase transition. From titration calorimetric and zeta potential data, saturation of LF binding to LPS was found to lie at a [LF]:[LPS] ratio of 1:3 to 1:5 M from the former and 1:10 M from the latter technique. X-ray scattering data indicate a change of the lipid A aggregate structure from inverted cubic to multilamellar, and with fluorescence (FRET) spectroscopy, LF is shown to intercalate by itself into phospholipid liposomes and may also block the lipopolysaccharide-binding protein (LBP)-induced intercalation of LPS. The LPS-induced cytokine production of human mononuclear cells exhibits a decrease due to LF binding, whereas the coagulation of amebocyte lysate in the Limulus test exhibited concentration-dependent changes. Based on these results, a model for the mechanisms of endotoxin inactivation by LF is proposed.

Conditions for solubilization of Tamm-Horsfall protein/uromodulin in human urine and establishment of a sensitive and accurate enzyme-linked immunosorbent assay (ELISA) method

Tamm-Horsfall protein (THP), also referred to as uromodulin, is a major glycoprotein produced by kidney cells. The level of THP in urine is an indicator of renal function. THP levels are difficult to quantify accurately, because the protein forms aggregates in the pH and ion concentrations found in urine. Here, we describe conditions by which THP can be solubilized and kept soluble during measurement using Triton X-100, EDTA, and alkaline pH. Establishing conditions for precise quantification of THP by enzyme-linked immunosorbent assay (ELISA) will aid in studying the functions of THP.

Physico-chemical analysis of lipid A fractions of lipopolysaccharide from Erwinia carotovora in relation to bioactivity

Highly purified bisphosphoryl, monophosphoryl and dephosphoryl lipids A from Erwinia carotovora with different acylation patterns were characterized physico-chemically. Applying matrix assisted laser desorption/ionization mass spectrometry, the purity of the lipid A fractions was determined, and from monolayer measurements the molecular space requirement was estimated. Fourier transform infrared spectroscopy allowed the elucidation of the gel to liquid crystalline phase transition of the acyl chains as well as the determination of the tilt angle of the diglucosamine backbone with respect to the acyl chain direction applying dichroitic measurements with attenuated total reflectance. With synchrotron radiation small-angle X-ray diffraction the supramolecular aggregate structure was determined, and with fluorescence resonance energy transfer spectroscopy the lipopolysaccharide binding protein induced intercalation of lipid A into a phospholipid matrix corresponding to that of the macrophage membrane was investigated. From the results, a clear dependence of the physico-chemical parameters on the particular lipid A structure can be followed. Furthermore, these parameters correlate well with the biological activities of the various lipids A as deduced from their ability to induce biological activity (Limulus assay and cytokine induction in mononuclear cells). These results contribute to a closer interpretation of the physico-chemical prerequisites for endotoxic activity as found for enterobacterial lipid A.

Cavernous sinus hemangioma treated with gamma knife radiosurgery: usefulness of SPECT for diagnosis--case report

A 79-year-old female presented with cavernous sinus hemangioma manifesting as double vision due to right oculomotor and trochlear nerve pareses. Computed tomography and magnetic resonance imaging revealed bony erosion and a right cavernous sinus tumor with "tail sign" after contrast medium administration. Thallium-201 (201Tl) single photon emission computed tomography (SPECT) showed low uptake within the tumor, and technetium-99m-human serum albumin-diethylenetriaminepenta-acetic acid SPECT disclosed high uptake within the tumor. 201Tl SPECT usually shows very high uptake in meningiomas and malignant tumors, so the tumor was considered to be an unrelated benign tumor. The patient underwent partial resection of the tumor. Histological examination of the specimen confirmed cavernous hemangioma. The oculomotor nerve paresis partially improved. Gamma knife radiosurgery was carried out 4 months after the operation. The tumor markedly shrank with full recovery of extraocular movement 6 months after radiosurgery. SPECT is useful for distinguishing cavernous sinus hemangiomas from other cavernous tumors. Radiosurgery should be performed after partial resection or biopsy for cavernous sinus hemangiomas and may be the initial treatment for patients with small cavernous sinus hemangioma if the diagnosis can be established based on neuroimaging.

Combination chemotherapy of cisplatin, ifosfamide, and irinotecan with rhG-CSF support in patients with brain metastases from non-small cell lung cancer

BACKGROUND

Brain metastases develop frequently in patients with non-small cell lung cancer (NSCLC), and the prognosis for these patients is very poor. We evaluated the role of chemotherapy for patients with brain metastases from NSCLC.

METHODS

We analyzed 30 patients who were discovered to have brain metastases during the diagnosis of 121 patients enrolled in three consecutive clinical trials on advanced NSCLC assessing combination chemotherapy of cisplatin, ifosfamide and irinotecan with rhG-CSF support. Response in the brain lesions was evaluated by contrast-enhanced MRI scans after at least two courses.

RESULTS

Fourteen patients achieved a partial response (PR) but there was no change (NC) in 13 patients and progressive disease (PD) in 1. Among patients with extracranial lesions, 18 had a PR and 11 had NC. The response rate in brain metastases was 50.0%, and that in extracranial primary and metastatic lesions was 62.1%. The median duration of response for intra- and extracranial lesions was 140 and 147 days, respectively. After completing chemotherapy, Gamma Knife radiosurgery was performed on 2 patients in remission and 8 patients at disease progression. The median survival time and 1-year survival rate were 382 days and 56.1%, respectively.

CONCLUSIONS

Both the response rate and survival data in this retrospective study suggest a high degree of activity of this combination chemotherapy in patients with brain metastases from NSCLC.

Characterization and functional expression of the cDNA encoding human brain quinolinate phosphoribosyltransferase

To elucidate the molecular basis underlying quinolinate metabolism, the cDNA encoding human brain QPRTase was cloned.

Identification of cDNAs encoding alpha-amino-beta-carboxymuconate-epsilon-semialdehyde decarboxylase (ACMSDase)

To elucidate the molecular basis underlying quinolinate metabolism, the cDNA encoding ACMSDase was cloned.

Molecular cloning and sequences of cDNAs encoding alpha (large) and beta (small) isoforms of human pancreatic zymogen granule membrane-associated protein GP2

cDNA clones encoding two different (alpha and beta) forms of human pancreatic zymogen granule membrane-associated protein glycoprotein 2 (GP2) (also referred to as ZAP75), a critical component in regulated membrane trafficking along the apical secretory pathway in pancreatic acinar cells, have been isolated. Structural analysis of the clones revealed that the alpha and beta forms of GP2 consist of 527 and 380 amino acid (aa) residues, respectively. The beta form lacks a 147 aa domain that corresponds to the 25-171 region of the alpha form, suggesting that it is a product of an alternative splicing event. Expression of both forms of GP2 in the human pancreas was confirmed. A unique isoform of GP2 is reported for the first time in humans.

Effect of long-term atrial-demand ventricular pacing on cardiac sympathetic activity

It has been shown that either dual-chamber or atrial pacing may be better than ventricular single-chamber pacing, but the long-term effect of dual-chamber pacing on cardiac sympathetic activity is unclear. The aim of this study was to assess the effect of long-term dual-chamber pacing on cardiac sympathetic activity, compared with atrial pacing and unpaced individuals. We studied 11 patients with dual-chamber pacemakers (Group D), nine with atrial single-chamber pacemakers (Group A) over the long term (mean 44 +/- 36 months) and 10 normal individuals without cardiac pacing. All underwent myocardial 123I-metaiodobenzylguanidine (MIBG) imaging to assess cardiac sympathetic activity. The heart-to-mediastinum (H/M) MIBG uptake ratio and the MIBG washout rate from the myocardium were calculated. Echocardiography was performed in all patients with cardiac pacing to assess left ventricular function. In Group D, the H/M ratio on delayed images was significantly lower than that of Group A (1.82 +/- 0.51 vs 2.56 +/- 0.50, P < 0.001) and normal individuals (2.65 +/- 0.35, P < 0.05). The myocardial MIBG washout rate of Group D was significantly higher than that of either Group A (52 +/- 13% vs 36 +/- 8%, P < 0.01) or normal individuals (31 +/- 7%, P < 0.05). Neither the H/M ratio nor MIBG washout rate differed significantly between patients in Group A and normal individuals. Furthermore, the echocardiographic parameters did not differ significantly between the two pacing groups. We conclude that long-term ventricular pacing, even in the presence of atrioventricular synchrony, accelerates cardiac sympathetic activity without deteriorating left ventricular function.

Estimation of the migration of tibial components in total knee arthroplasty. A roentgen stereophotogrammetric analysis

Accurate quantitative measurements of micromovement immediately after operation would be a reliable indicator of the stability of an individual component. We have therefore developed a system for measuring micromovement of the tibial component using three non-contact displacement transducers attached to the tibial cortex during total knee arthroplasty (TKA). Using this system we measured the initial stability in 31 uncemented TKAs. All the tibial components were fixed by a stem and four screws. The initial stability was defined as the amount of displacement when a load of 20 kg was applied. The mean subsidence was 60.7 microm and the mean lift-off was 103.3 microm. We also studied the migration of the tibial component using roentgen stereophotogrammetric analysis (RSA) for up to two years after operation. Most migration occurred during the first six months, after which all prostheses remained stable. We defined migration as the maximum total point motion (MTPM) at two years after operation. The mean migration was 1.29 mm at two years. Our results show that there was a significant correlation between the initial stability and migration (p < 0.05) and emphasise the importance of the initial stability of the tibial component.

Estimation of the migration of tibial components in total knee arthroplasty

Accurate quantitative measurements of micromovement immediately after operation would be a reliable indicator of the stability of an individual component. We have therefore developed a system for measuring micromovement of the tibial component using three non-contact displacement transducers attached to the tibial cortex during total knee arthroplasty (TKA). Using this system we measured the initial stability in 31 uncemented TKAs. All the tibial components were fixed by a stem and four screws. The initial stability was defined as the amount of displacement when a load of 20 kg was applied. The mean subsidence was 60.7 μm and the mean lift-off was 103.3 μm.

We also studied the migration of the tibial component using roentgen stereophotogrammetric analysis (RSA) for up to two years after operation. Most migration occurred during the first six months, after which all prostheses remained stable. We defined migration as the maximum total point motion (MTPM) at two years after operation. The mean migration was 1.29 mm at two years.

Our results show that there was a significant correlation between the initial stability and migration (p < 0.05) and emphasise the importance of the initial stability of the tibial component.

A novel spore peptidoglycan hydrolase of Bacillus cereus: biochemical characterization and nucleotide sequence of the corresponding gene, sleL

The exudate of germinated spores of B. cereus IFO 13597 in 0.15 M KCl-50 mM potassium phosphate (pH 7.0) contained a spore-lytic enzyme which has substrate specificity for fragmented spore cortex from wild-type organisms (cortical-fragment-lytic enzyme [CFLE]), in addition to a previously characterized germination-specific hydrolase which acts on intact spore cortex (spore cortex-lytic enzyme [SCLE]) (R. Moriyama, S. Kudoh, S. Miyata, S. Nonobe, A. Hattori, and S. Makino, J. Bacteriol. 178:5330-5332, 1996). CFLE was not capable of degrading isolated cortical fragments from spores of Bacillus subtilis ADD1, which lacks muramic acid delta-lactam. This suggests that CFLE cooperates with SCLE in cortex hydrolysis during germination. CFLE was purified in an active form and identified as a 48-kDa protein which functions as an N-acetylglucosaminidase. Immunochemical studies suggested that the mature enzyme is localized on a rather peripheral region of the dormant spore, probably the exterior of the cortex layer. A gene encoding the enzyme, sleL, was cloned in Escherichia coli, and the nucleotide sequence was determined. The gene encodes a protein of 430 amino acids with a deduced molecular weight of 48,136. The N-terminal region contains a repeated motif common to several peptidoglycan binding proteins. Inspection of the data banks showed no similarity of CFLE with N-acetylglucosaminidases found so far, suggesting that CFLE is a novel type of N-acetylglucosaminidase. The B. subtilis genome sequence contains genes, yaaH and ydhD, which encode putative proteins showing similarity to SleL.

Assessment of subchondral bone blood flow in the rabbit femoral condyle using the laser speckle method

The laser speckle method is a new form of flowmetry that can obtain a two-dimensional distribution of blood flow in tissue. This method is a noncontact, simple, and rapid technique that may aid in the diagnosis of osteonecrosis. We investigated whether the subchondral bone blood flow within the femoral condyles of rabbits could be measured by the laser speckle method. The hydrogen washout method was chosen as a comparison technique because of its ability to allow repetitive measurements of blood flow in various conditions in one rabbit and because of its reliability, which already has been established. We simultaneously measured the bone blood flow in 20 femoral condyles of 10 rabbits with the laser speckle and hydrogen washout methods and found a significant correlation between the blood flow levels with use of these two methods. For the clinical application of the laser speckle method, we also investigated the influence of cartilage thickness on the measurements and the depth in the bone to which blood flow could be measured with this method. A cartilage thickness of 0.2 mm did not influence the measurement of the bone blood flow, and the depth in the bone to which the laser speckle method could be used was approximately 2 mm.

Evaluation of blood flow within the subchondral bone of the femoral head: use of the laser speckle method at surgery for osteonecrosis

The laser speckle method is a new form of tissue flowmetry that can analyze the interference pattern that appears when tissue is illuminated with a laser beam. During surgery for 100 cases of osteonecrosis of the femoral head, we measured the blood flow within the subchondral bone using this method. We compared the flow maps (two-dimensional distribution of the microcirculation) obtained this way with the necrotic area estimated by the preoperative magnetic resonance images and with the collapse seen during surgery. The laser speckle method was able to distinguish between the ischemic areas and the normal areas in 92 femoral heads, including five hips for which neither the magnetic resonance images nor the collapse observed during surgery demonstrated a distinct margin surrounding the necrotic area. We concluded that the laser speckle method is useful for defining the margin around a necrotic area.

Apoptosis following gamma knife radiosurgery in a case of acoustic schwannoma

A 25-year-old woman with a large acoustic schwannoma underwent surgical excision 18 months after Gamma Knife radiosurgery because of transient expansion of the tumor causing ataxia. Histopathologial investigation by the TUNEL method revealed the presence of some apoptotic cells. The findings were compared with findings from a control group of 7 operated cases where radiosurgery had not been used. There was no apoptosis found in any of these cases. In addition, another case which resulted in a regrowing tumor following Gamma Knife treatment also showed no apoptosis. These findings suggest apoptosis may be a possible mechanism in reducing tumor size following Gamma Knife radiosurgery.