Usefulness of soluble CD163 as a biomarker for macrophage activation syndrome associated with systemic lupus erythematosus

OBJECTIVE

We aimed to study the usefulness of serum soluble CD163 (sCD163) as a biomarker for macrophage activation syndrome (MAS) associated with systemic lupus erythematosus (SLE).

METHODS

Serum sCD163 levels were retrospectively measured by enzyme-linked immunosorbent assay for SLE patients associated with MAS (SLE-MAS), lupus nephritis (LN), or autoimmune hemolytic anemia (AIHA) and/or immune thrombocytopenia (ITP) and healthy controls (HCs). Posttreatment samples were also evaluated in the available SLE-MAS patients. The associations between serum sCD163 levels and clinical information were statistically analyzed.

RESULTS

The serum sCD163 levels in SLE-MAS, LN and SLE-AIHA/ITP groups were significantly higher than those in HCs (n = 17, 29, 13, and 68, respectively; p < 0.01 for all comparisons). In addition, the serum sCD163 levels in the SLE-MAS group were even higher than those in the LN and SLE-AIHA/ITP groups (p < 0.01 for both comparisons). Serum sCD163 levels were correlated with the SLE Disease Activity Index 2000 scores (r = 0.53), whereas they were not correlated with the serum ferritin levels. With the determined cut-off value, the sensitivity and specificity of serum sCD163 for the diagnosis of SLE-MAS were 59% and 86%, respectively. Retesting showed that the serum sCD163 levels decreased significantly following treatment in parallel with disease amelioration in the SLE-MAS group (p < 0.01).

CONCLUSIONS

The present study suggests the usefulness of serum sCD163 as a diagnostic and disease-activity biomarker for SLE-associated MAS. Serum sCD163 might also have a different role as a biomarker for SLE-associated MAS than serum ferritin does.

Reliability of the SF-36 in Japanese patients with systemic lupus erythematosus and its associations with disease activity and damage: a two-consecutive year prospective study

We aimed to validate the reliability of the Medical Outcomes Study Short Form-36 (SF-36) among Japanese patients with systemic lupus erythematosus (SLE). Japanese patients with SLE ( n = 233) completed the SF-36 and other related demographic questionnaires, and physicians simultaneously completed the SLE Disease Activity Index 2000 (SLEDAI-2K) and the Systemic Lupus International Collaborating Clinics Damage Index (SDI). Patients were prospectively followed for a repeat assessment the following year. The SF-36 subscales demonstrated acceptable internal consistency (Cronbach’s α of 0.85–0.89), and an overall good test–retest reliability (intraclass correlation coefficient >0.70). The average baseline SF-36 subscale/summary scores except for “bodily pain” were significantly lower than those of the Japanese general population ( p < 0.05). The SDI showed an inverse correlation with the SF-36 subscale/summary scores except for “vitality” and “mental component summary” at baseline, whereas the SLEDAI-2K did not. In the second year, “social functioning” and “mental component summary” of the SF-36 deteriorated among patients whose SDI or SLEDAI-2K score increased (effect sizes < −0.20). In conclusion, the SF-36 demonstrated acceptable reliability among Japanese patients with SLE. Health-related quality of life measured by the SF-36 was reduced in Japanese patients with SLE and associated with disease damage, rather than disease activity.

Validation of the Japanese version of the Systemic Lupus Activity Questionnaire that includes physician-based assessments in a large observational cohort

The Systemic Lupus Activity Questionnaire (SLAQ) is a patient-reported outcome for systemic lupus erythematosus (SLE). We aimed to translate it into Japanese and further investigate its validity and reliability. The English version of the SLAQ was translated into Japanese and administered to Japanese SLE patients at our university clinic. Physicians assessed disease activity using the SLE Disease Activity Index 2000 (SLEDAI-2K). The patients were prospectively followed for repeat assessment a year later. Ultimately, 255 patients participated. The patients’ 10-point ratings of disease activity and SLAQ scores were significantly correlated (Spearman’s ρ = 0.53). The SLAQ score was weakly correlated with the SLE Disease Activity Index 2000 (SLEDAI-2K)-nolab (omitting laboratory items; ρ = 0.18) but not with the SLEDAI-2K ( ρ = 0.02). These results suggested its convergent and discriminant validity. The SLAQ demonstrated acceptable internal consistency (Cronbach’s α = 0.80), and good test–retest reliability (intraclass correlation coefficient = 0.85). The effect sizes and the standardized response means of the SLAQ were as follows: clinical worsening, 0.26 and 0.31, and improvement, −0.39 and −0.41, respectively, which indicated a small but significant responsiveness. The Japanese version of the SLAQ demonstrated acceptable reliability and validity; its performance was comparable to that of the original version.

Detection of Corynebacterium kutscheri in the faeces of subclinically infected mice

Mice were infected experimentally and subclinically with Corynebacterium kutscheri to recover the organism from mice faeces. The faeces were then cultured using selective furazolidone-nalidixic acid-colimycin agar. The number of C. kutscheri per gram of fresh faeces varied from mouse to mouse, but once established in the intestine, the organism was excreted in the faeces for at least five months. Viable bacteria were detected in most of the faecal samples, including those stored in the animal room for five days. The number of organisms in the stored faeces decreased gradually but did not differ significantly from those in the fresh faeces until they had been stored for more than three days. Many infected mice excreted between 10(4.77) and 10(5.37) colony forming units (CFU) of C. kutscheri per day in their faeces, and one mouse even excreted 10(3.74) CFU at eight weeks postinfection. These values showed little daily variation. Our present study showed that subclinically infected mice discharged the organism continuously and persistently in their faeces. Therefore, faecal samples would be useful for monitoring infection with C. kutscheri in living mice in a manner that is not stressful for the animals.

Intramolecular quadruplex formation of the G-rich strand of the mouse hypervariable minisatellite Pc-1

The minisatellite Pc-1, isolated from the mouse genome consisting of a tandem repeat of d(GGCAG), is hypervariable with a mutation rate of 0.15/generation. Here we describe a structural characterization of the G-rich strand of Pc-1 by biochemical and physicochemical methods. It was found to be comparatively resistant to both single-stranded DNA-binding protein binding and digestion by single-stranded DNA-specific nuclease and to cause arrest of DNA synthesis. The guanine imino proton NMR signals observed on the Pc-1 G-rich strand and their slow (1)H/(2)H exchange profiles pointed to a quadruplex structure with guanine quartets. The melting temperature of the quadruplex determined by CD was not dependent on DNA concentration. These results indicate that the G-rich strand of Pc-1 forms an intramolecular folded-back quadruplex structure under physiological conditions. Possible mechanisms of the Pc-1 mutations implicated with the formation of the quadruplex structure are discussed.

MCI-154, a Ca2+ sensitizer, increases survival in cardiomyopathic hamsters

To assess the long-term efficacy of a Ca2+ sensitizer MCI-154, 6-[4-(4'-pyridylamino)phenyl]-4,5-dihydro-3(2H)-pyridazinone hydrochloride trihydrate, on chronic heart failure, we studied the effects of the agent on the life span of cardiomyopathic hamsters of the BIO-14.6 strain. At approximately 150 days of age, 210 male hamsters were randomly divided into three groups: MCI-154 0.1 mg kg(-1), day(-1)(MCI-154-low), MCI-154 1 mg kg(-1) day(-1) (MCI-154-high), and control group. The median survival time in control, MCI-154-low and MCI-154-high groups was 227, 243 and 260 days after the start of treatment, respectively. Final survival rate at 284 days in control, MCI-154-low and MCI-154-high groups was 0, 17.1 and 38.6%, respectively. The cumulative survival times in the two MCI-154 treated groups were significantly prolonged in comparison with that in the control group (P < 0.0001). Thus, the present study clearly showed that MCI-154 prolonged the life span of cardiomyopathic hamsters, suggesting that long-term therapy with MCI-154 would be promising in the treatment of congestive heart failure.

Interleukin-12 activates human gamma delta T cells: synergistic effect of tumor necrosis factor-alpha

gammadelta T cell populations are known to expand in response to intracellular bacterial infectious agents regardless of previous priming. We have shown previously that soluble factor(s) produced by Mycobacterium-stimulated monocytes activate cord blood gammadelta T cells to proliferate. In this study, we investigated whether cytokines produced by monocytes are responsible for gammadelta T cell activation in vitro: interleukin (IL)-1beta, IL-6, IL-8, IL-12, tumor necrosis factor (TNF)-alpha and granulocyte/macrophage colony-stimulating factor were examined. Recombinant human IL-12 stimulated gammadelta T cells, but not alphabeta T cells in peripheral blood mononuclear cells, to express CD25 on their surfaces, and to expand in number in vitro. IL-12-primed gammadelta T cell numbers increased to a greater extent in the culture to which exogenous IL-2 (5 U/ml) was added. Anti-TNF-alpha monoclonal antibody inhibited IL-12-induced up-regulation of CD25 on gammadelta T cells, suggesting that endogenous TNF-alpha may play a role in IL-12-induced activation of gammadelta T cells. Recombinant TNF-alpha synergistically augmented IL-12-induced activation of gammadelta T cells. Furthermore, IL-12 up-regulated TNF receptors on gammadelta T cells in vitro: TNF-alpha binding to its receptor induced CD25 expression on the gammadelta T cells in an autocrine or paracrine fashion, or perhaps both. It also became evident that both IL-12 and TNF-alpha were produced by mycobacterial lysate-stimulated monocytes. Taken together, these results suggest that upon confrontation with mycobacterial organisms, gammadelta T cells can be quickly and antigen-nonspecifically activated by soluble factors including IL-12 and TNF-alpha, both of which are produced by mononuclear phagocytes in response to mycobacterial organisms.

Effects of ONO-1101, a novel beta-antagonist, on action potential and membrane currents in cardiac muscle

Direct effects of ONO-1101 ¿(-)-[(S)-2,2-dimethyl-1,3-dioxolan-4-yl]methyl-3-[4-[(S) -2-hydroxy-3-(2-morpholino carbonylamino)ethylamino] propoxy]phenylpropionate monohydrochloride), a novel beta-antagonist, on action potential parameters and membrane currents, and its beta adrenoceptor antagonism were examined in cardiac muscle. Action potential-parameters in papillary muscle of reserpinized animals and membrane currents recorded from single myocytes obtained from guinea pig and rabbit hearts were not affected by 1 to 100 microM ONO-1101. On the other hand, ONO-1101 markedly inhibited the potentiation of Ca current by isoproterenol in single cardiac myocytes of the guinea pig. The concentration-response relationship of Ca current for isoproterenol was shifted to the right. This effect resembled that of esmolol, which is also a beta adrenoceptor antagonist. A Schild plot analysis revealed the slope and pA2 value of each antagonist (ONO-1101, 0.94, 8.0; and esmolol, 0.98, 7.3, respectively) and demonstrated that ONO-1101 is about 5 times more potent than esmolol as a beta-antagonist. Two other effects of isoproterenol: 1) potentiation of delayed rectifier K current and 2) activation of chloride current, were also inhibited by ONO-1101. The time required for 50% removal of beta-antagonism of ONO-1101 and esmolol after the washout was estimated as 4 and 6 min, respectively, in depolarized papillary muscle. These results suggest that ONO-1101 is a potent beta-antagonist whose effects were removed quickly by washout. When applied at what is thought to be a clinical dosage, ONO-1101 had no direct effects on action potential-parameters and membrane currents in cardiac muscle. These characteristics of ONO-1101 suggest that this agent may be effective in clinical use.

Increase of gamma/delta T cells in hospital workers who are in close contact with tuberculosis patients

gamma/delta T cells are likely to participate in the immune response to tuberculous infection in humans. In this study, we carried out an investigation to characterize the responsiveness of gamma/delta T cells from tuberculous patients and healthy individuals to mycobacterial stimulation in vitro. Healthy subjects were assigned to the following two groups: those who had been exposed to tuberculosis (contacts) and those who had not been exposed (noncontacts). The percent gamma/delta T cells in fresh peripheral blood obtained from health care workers who were tuberculin skin test positive and who had constant contact with patients with active tuberculosis (healthy contacts) was significantly higher, whereas healthy noncontacts showed the normal range of gamma/delta T cells. Patients with active pulmonary tuberculosis also had low levels of gamma/delta T cells. HLA-DR antigen-bearing activated gamma/delta T cells were observed in higher percentages among healthy contacts than among healthy noncontacts or patients with pulmonary tuberculosis. In healthy contacts, gamma/delta T cells increased as a percentage of peripheral blood mononuclear cells after in vitro stimulation with purified protein derivative (PPD) tuberculin compared with the percentage of fresh peripheral blood mononuclear cells that they made up, whereas no such increase was observed in patients with tuberculosis or in healthy noncontacts. Phenotypic analysis of the gamma/delta T cells in healthy contacts, which increased in number in vitro in response to PPD, revealed the preferential outgrowth of CD4+ V gamma 2+ gamma/delta T cells. This expansion of gamma/delta T cells by PPD required accessory cells, and it was inhibited by the addition of an antibody against HLA-DR in culture. Proteolytic digestion of PPD showed that gamma/delta T cells increased in number in response to peptide, but not nonpeptide, components of PPD. These findings suggest that gamma/delta T cells, especially CD4+ V gamma 2+ gamma/delta T cells, may participate in the immune surveillance of tuberculous infections in humans.

Increase of T-cell receptor gamma/delta-bearing T cells in cord blood of newborn babies obtained by in vitro stimulation with mycobacterial cord factor

Cord blood T lymphocytes proliferated in vitro in response to mycobacterial organisms but did not proliferate in the presence of tuberculin purified protein derivative. Components recognized by cord blood T cells were resistant to protease digestion. In contrast, T lymphocytes derived from tuberculin-positive adult peripheral blood proliferated when stimulated by the protease-sensitive component of mycobacterial organisms or purified protein derivative, confirming that adult T cells respond to protein components whereas cord blood T cells respond to the nonpeptide component of mycobacteria. In vitro culture of cord blood lymphocytes stimulated by either mycobacterial lysates or the lipid fraction showed increases in the numbers of T-cell receptor (TcR) gamma/delta T lymphocytes with no changes in the numbers of TcR alpha/beta T lymphocytes in contrast to the in vitro cultures of adult blood lymphocytes stimulated with mycobacterial ligands in which no increase of TcR gamma/delta cells was observed. Interleukin-2 receptor (CD25) and Ia antigen (HLA-DR) analyses evidenced the activation of a large proportion of cord blood gamma/delta T cells which had increased after stimulation with mycobacteria in vitro. Further characterization of mycobacterial ligand suggested that the lipid fraction of mycobacterial lysate or trehalose dimycolate-cord factor was the most plausible cause for T-cell proliferation in cord blood. These results suggest that when the gamma/delta T cells in a newborn infant not yet sensitized to any pathogenic organisms are confronted by a mycobacterium, they respond nonspecifically to the mycobacterial organism or its lipid component (cord factor). gamma/delta T cells may therefore play a distinct role in forming the first line of the host defense system against certain microorganisms.

Mycobacterium avium-Mycobacterium intracellular complex-induced suppression of T-cell proliferation in vitro by regulation of monocyte accessory cell activity

Heat-killed whole Mycobacterium avium-Mycobacterium intracellulare complex (MAC) and its lipid component impaired the capacity of human peripheral blood mononuclear cells to proliferate in vitro in response to concanavalin A (ConA), purified protein derivative of tuberculin (PPD), and to a lesser degree, phytohemagglutinin stimulation. Inhibition by MAC was not contingent upon prior exposure of the donor to MAC or other mycobacteria and occurred with lymphocytes from tuberculin-negative as well as -positive subjects. The suppression was not due to the toxicity of MAC. The suppression by MAC was not blocked by indomethacin. Adherent cell depletion and cell mixing experiments with T cells indicated that monocytes and not T cells were a major contributor to the immunosuppression observed. However, neither interleukin-1 production nor the expression of HLA-DR (Ia antigen) by monocytes was suppressed by MAC treatment. On the other hand, treatment of monocytes with MAC or MAC-derived lipid resulted in significant decreases in CD11b, a member of the leukocyte function-associated molecule-1 and LeuM3 (CD14) molecule. Anti-CD18 (beta-chain of the leukocyte function-associated molecule-1 family) monoclonal antibody had suppressive effects on ConA- and PPD- but not phytohemagglutinin-induced in vitro lymphocyte blastogenesis. We suggest that MAC and MAC-derived lipid suppress the ConA- and PPD-induced T-cell proliferations by blocking the expression of accessory molecules on the surfaces of monocytes which might be involved in nonspecific monocyte-T-cell interactions and not by inhibiting either monocyte Ia antigen expression or interleukin-1 production by monocytes.

Cocarcinogenic activity of bile acids in the chemical transformation of C3H/10T1/2 fibroblasts in vitro

We have performed a series of experiments to determine directly whether bile acids influence carcinogenesis, using a C3H/10T1/2 cell transformation system in vitro. Treatment of the cells with the carcinogen, 3-methylcholanthrene (MCA), followed by the addition of lithocholic acid (LCA), produced a marked increase in the number of transformed foci as compared to the number induced by MCA alone. Simultaneous treatment with MCA and bile acid did not increase the number of transformed foci except in the case of MCA in combination with LCA. When cultured cells were exposed to MCA soon after removal of cholic acid or LCA, a statistically significant increase in the number of transformed foci was noted. When cultured cells were replated after continuous exposure to test compounds and then treated with MCA, no enhancement of the rate of formation of transformed colonies was observed. From these results, it appears that bile acids act as not only promoting but also as co-carcinogenic agents under certain circumstances.

Comparative study of gastric cancer in young and aged patients

Clinical and pathological findings of gastric cancer in patients of less than 30 years of age were compared with those in aged patients of over 75 years of age. These were 10 males and 24 females, and the rate of gastric cancer for females in the younger group was extremely high. There were marked differences between both groups in the pathological findings of gastric cancer, and consequently in the progressive pattern of the disease, perhaps as the result of differences in the matrix of cancer development and the influence of sex hormones. Gastric cancer at an advanced stage and delayed surgery in younger patients are attributable to negligence on the part of the patient in scheduling a medical examination and careless diagnosis by the physician. However, the prognosis of gastric cancer was not unfavorable in the younger patients when curative surgery was performed.

Pathological characteristics of gastric cancer that develop hematogenous recurrence, with special reference to the site of recurrence

The pathologic characteristics of gastric cancer in 57 patients with hematogenous recurrence were pathologically analyzed by the site of recurrence. In recurrence of gastric cancer that developed in the liver, macroscopic observation revealed that cancers of Borrmann type 2 and 3 were most frequent. Microscopic examination revealed that the rate of occurrence of the medullary type of differentiated or poorly differentiated adenocarcinoma were high and that there were relatively frequent invasion by cancerous cells of the blood vessel that were closely related to the hematogenous metastasis. On the other hand, with respect to recurrence of gastric cancer that had developed in the lung or bone, Borrmann type 3 and 4, respectively, were more frequently observed. In these cases, microscopic analysis revealed that these cancers were poorly differentiated adenocarcinomas. In gastric cancer with bone recurrence, the rate of recurrence of the scirrhous type of tumor were higher than that of other types. It is important, for the management of patients after gastric cancer surgery, to predict possible hematogenous recurrence and its site by evaluation of the pathologic characteristics of the gastric cancer.

Prognostic significance of lymph vessel involvement in gastric cancer

We studied the prognostic significance of lymph vessel involvement in the gastric wall in 226 patients with advanced gastric cancer. There was no close correlation between the gross morphology of the cancer and the incidence of lymph vessel invasion. However, the more severe the degree of lymph vessel involvement, the higher was the incidence of lymph node metastasis. Severe lymph vessel invasion was found most frequently in poorly differentiated adenocarcinoma of the medullary type. Among patients with scirrhous carcinoma there were some in whom lymph vessel involvement was overlooked on routine histologic examination. Because the depth of lymph vessel invasion of the gastric wall was significantly related to the clinical course, we consider this to be of supplementary predictive value.

[Types of surgical operations and cancer development]

Experimental and clinical studies were undertaken to examine whether carcinogenesis in particular organs is influenced by types of surgical operations resulting in an alteration of bile acid excretion and metabolism. A higher incidence of remnant gastric carcinoma was noted in rats receiving gastrectomy with a greater amount of duodenogastric reflux. Furthermore, carcinogenesis was enhanced in gastrectomized rats that had been fed on a high-cholesterol diet causing an increase in bile acid excretion. In a human study, however, there was no relationship between gastrectomy and the incidence of remnant stomach carcinoma. Intestinal surgery alters bile acid metabolism, which may promote colon carcinogenesis. In patients receiving ileocecal resection or right hemicolectomy, the amount of total fecal bile acids was markedly increased as compared to the normal controls. A retrospective study on the incidence of metachronous colorectal cancer in our department showed that the incidence was 12.2% in patients with ileocecal resection in contrast to 4.4% in those with left-side colon resection. These findings suggest that there is a relationship between previous ileocecal resection and the development of metachronous colon carcinoma. We could not obtain any evidence of cholecystectomy having an increased risk for the development of colorectal carcinoma.

Carcinoembryonic antigen slope analysis as an early indicator for recurrence of colorectal carcinoma

We analyzed the time course of postoperative serum CEA concentrations in 229 patients with histologically confirmed colorectal carcinoma. Preoperative CEA levels were correlated with Dukes' stages, however, the preoperative CEA value was of limited value as a screening procedure. In 42 patients with tumor recurrence after radical resection, a diagnosis of relapse, based on a rise in the CEA concentration, preceded the positive clinical symptoms. Analysis of the CEA time course made it possible to differentiate local tumor recurrence and generalized metastasis, regardless of the histologic type or primary site of the tumor.

High incidence of liver metastasis in gastric cancer with medullary growth pattern

We studied the histology of resected specimens from 71 gastric cancer patients with synchronous and metachronous liver metastasis to assess the predominance of a particular histological pattern in gastric cancer with a tendency for liver metastasis. Poorly differentiated adenocarcinoma manifesting a medullary growth pattern was the most frequent histologic pattern (33%), followed by papillary adenocarcinoma (28%) in 39 patients with synchronous liver metastasis. In 32 patients who developed metachronous liver metastasis as the main pattern of recurrence, papillary adenocarcinoma was most frequent (47%), followed by poorly differentiated adenocarcinoma of the medullary type (28%). Scirrhous carcinoma was not encountered in patients manifesting metachronous liver metastasis. As most of the papillary adenocarcinomas exhibited a medullary growth pattern, we hypothesize that gastric cancer of the medullary type tends to metastasize to the liver, irrespective of the basic histologic pattern, and that poorly differentiated adenocarcinoma of the medullary type has a particularly high tendency for metastasizing to the liver.

[Metachronous hematogenous metastasis of gastric cancer--histopathologic characteristics of gastric cancer developing of the liver, lung or bone metastasis]

Fifty-seven gastric cancer patients developing metachronous hematogenous metastasis were histopathologically analyzed. In 37 patients who developed metachronous liver metastasis as the main pattern of recurrence, papillary adenocarcinoma was the most frequent histologic type, followed by poorly differentiated adenocarcinoma of the medullary type. In 20 patients with metachronous lung or bone metastasis, poorly differentiated adenocarcinoma of the scirrhous type was the common histologic pattern. From the present data, we assume that liver metastasis of gastric cancer occurs when cancer cell clusters are transported to the liver, where they attach and proliferate, whereas single cells passed through the portal system tend to establish secondary deposits in the lung or bone.