Myocardial adaptive changes and damage in ischemic heart disease

Changes in two of the elements of myocardial subcellular organelles relating to cardiac energetics, ventricular myosin isozymes and mitochondrial DNA mutations, were examined using left ventricular tissue samples obtained at autopsy from patients with ischemic heart disease. Myosin isozymes were examined in tissues from nine patients with ischemic heart disease and 12 control patients with cancer but no heart disease. Extracted myosin was separated by pyrophosphate gel electrophoresis. The relative concentration of each component was determined by densitometry. Mitochondrial DNA mutations were evaluated in tissues from ten patients with myocardial infarction and 11 control patients with cancer but no heart disease. DNA was extracted and mitochondrial DNA mutations were detected by the polymerase chain reaction. Two bands were revealed by pyrophosphate gel electrophoresis. These contained VM-A, which exhibited faster electrophoretic mobility and was present in lower concentrations, and VM-B, which had a lower mobility and a higher concentration, respectively. SDS polyacrylamide gel electrophoresis showed that these two components contained the heavy chain and light chains 1 and 2 of myosin. VM-A concentrations tended to be higher in patients with ischemic heart disease than in controls. A 7.4-kb deletion was detected between the D-loop and the ATPase 6 genes of mitochondrial DNA from the myocardium of 6 out of 10 patients with myocardial infarction. The relative amounts of the two myosin isozymes could be altered by ischemic heart disease, although the functional significance of these components is unclear. The changes in the two myosin isozymes might be an adaptive change to disordered energy metabolism, but this change was small. The myocardial mitochondrial DNA deletions in patients with myocardial infarction were thought to result from ischemic damage.

[Changes with aging in ECochG]

The present study was designed to determine the standard values of AP, adapted AP and CM (0.5, 1, 2, and 4kHz) of the electrocochleogram using subjects with normal hearing (20 ears, mean subject age 30.4 years). The input-output function, the latency and the threshold were measured in AP, whereas only an input-output curve was made for the adapted AP and the input-output function and the threshold were measused in CM. The CM threshold had the highest positive correlation with the threshold of the conventional pure tone audiometry at 1kHz. These standard curves will be very useful for analysing clinical data. In order to discuss the aging changes affecting electrocochleograms, the test subjects were divided into two groups, i.e. one group was composed of subjects under 30 years of age (mean: 19.7 y/o, 10 ears) and the other of those 30 years old or over (mean: 41.1y/o, 10 ears). There were no differences in hearing threshold or the threshold of the electrocochleogram between the two groups. The CM threshold exhibited the highest positive correlation with the threshold of conventional audiometry at 1kHz in both groups. AP and adapted AP showed no difference in any item between the two groups. Although there was no difference in the CM threshold, there was an obvious difference in the CM input-output curves between these two groups at high stimulus intensities of 2 and 4kHz. It is known that the EP decrement makes CM smaller. However, it is unlikely that this decreased CM response in the older group was due to EP suppression, since this phenomenon was only observed in response to high intensity stimulo and there was no difference in responses to low intensity stimulo. Another possible explanation for this phenomenon is aging changes in the basilar membrane, tectorial membrane and hair cells. Further studies are necessary to elucidate the etiology of the CM suppression revealed in the present study.

Distribution of inflammation and atrophy in the stomach of Helicobacter pylori-positive and -negative patients with chronic gastritis

OBJECTIVES

To investigate the extent of inflammation and atrophy in the stomach of Helicobacter pylori-positive and -negative patients with chronic gastritis.

METHODS

Endoscopy with biopsies from the lesser curvatures of the antrum, angulus, middle body, and the greater curvature of the middle body of the stomach was performed in 59 patients with histologically confirmed chronic gastritis. The extent of atrophic gastritis was assessed endoscopically as well histologically. H. pylori status was assessed by histology as well as enzyme-linked immunosorbent assay. The histological severity of chronic and acute inflammation, glandular atrophy, and intestinal metaplasia was assessed according to the Sydney system.

RESULTS

In H. pylori-positive patients, H. pylori was evenly distributed throughout the stomach when the extent of atrophic gastritis was limited to the antrum and the lesser curvature of the body, but disappeared from the antrum of patients with more extensive atrophic gastritis. The severity of acute and chronic inflammation at the greater curvature of the body increased with the extension of atrophic gastritis. In H. pylori-negative patients, the severity of chronic inflammation at the greater curvature of the body was significantly higher in patients with extensive atrophic gastritis than in those with a lesser extent of atrophic gastritis.

CONCLUSION

At the greater curvature of the body, the development of atrophy is closely associated with the increase in the severity of inflammation, which is more marked in H. pylori-positive patients.

Mitochondrial DNA mutations associated with the 11778 mutation in Leber's disease

To clarify the characteristics of possible synergestic mitochondrial DNA (mtDNA) mutations associated with Leber's hereditary optic neuropathy (LHON), we analyzed the entire nucleotide sequences of mitochondrial genome of two Japanese patients from independent pedigrees harboring the 11778 mtDNA mutation, and compared their sequences with those of 47 disease and 6 normal controls. We have detected several unique mutations in the mtDNA in addition to the 11778 mutation. Two nucleotide substitutions, an A-to-G transition at position 856 in the 12S rRNA gene and an A-to-G transition at 14692 in the T psi C loop of the tRNA(Glu) gene, occurred at highly conserved sites among various species. These mutations in combination with the 11778 mutation might synergetically contribute to the pathogenesis of LHON.

The extracellular region of granulocyte colony-stimulating factor receptor in solution has multiple oligomerization states without ligand

Expression and purification of the extracellular portion of granulocyte colony-stimulating factor (G-CSF) receptor, which contains an immunoglobulin-like (Ig) domain and the cytokine receptor homologous (CRH) region, using a baculovirus secretion system have shown that a tetrameric Ig-CRH protein (about 200 kDa) existed in addition to the dimer (85 kDa) [7]. Scatchard analysis revealed that the tetramer had ligand binding affinity, with a dissociation constant of about 2.5 nM. The tetramer dissociated into monomers at pH 2 and was re-formed at pH7, in contrast, the dimer was re-dimerized with the same treatment. These observations led us to hypothesize the existence of conformational heterogeneity, which leads to tetramer as well as dimer formation, in the soluble state of the Ig-CRH protein.

Formation of 1:1 complex of the cytokine receptor homologous region of granulocyte colony-stimulating factor receptor with ligand

The cytokine receptor homologous (CRH) region of the murine granulocyte colony-stimulating factor (G-CSF) receptor was secreted using a Escherichia coli maltose binding protein (MBP) fusion system. The CRH region was prepared from the periplasmic fraction by G-CSF affinity column chromatography and restriction protease factor Xa digestion, and was purified to homogeneity. The purified CRH region specifically bound G-CSF, with an apparent dissociation constant (kd) of about 1.5 x 10(-9) M. A 1:1 CRH.G-CSF complex was established by gel-filtration high pressure liquid chromatography (HPLC). However, a 2:1 stoichiometric complex was not established, as in the case of the growth hormone (GH) receptor [Recent Prog. Hormone Res., 48, 233-275 (1993)].

Ligand binding characteristics of the carboxyl-terminal domain of the cytokine receptor homologous region of the granulocyte colony-stimulating factor receptor

The carboxyl-terminal domain (BC domain, roughly 100 amino acid residues) of the cytokine receptor homologous region in the receptor for murine granulocyte colony-stimulating factor was secreted as a maltose binding protein fusion into the Escherichia coli periplasm. The murine BC domain was prepared from the fusion protein by restriction protease factor Xa digestion and was purified to homogeneity. The purified BC domain specifically and stoichiometrically bound granulocyte colony-stimulating factor. This result indicates that the BC domain is also critical for ligand binding, as shown for the amino-terminal domain of the cytokine receptor homologous region (Hiraoka, O., Anaguchi, H., Yamasaki, K., Fukunaga, R., Nagata, S., and Ota, Y. (1994) J. Biol. Chem. 269, 22412-22419). The tertiary folding and the beta-sheet structure of the BC domain were confirmed by NMR spectroscopy. The disulfide bond pattern suggested from peptide mapping was Cys224-Cys271 and Cys242-Cys285. Disruption of the disulfide bonds suggested that both bonds are critical for maintaining the folding of the BC domain, although a BC domain lacking the second bond still retained ligand binding activity. Mutational analysis of the WSXWS sequence conserved in the cytokine receptor family suggested that this motif is critical for protein folding rather than for ligand binding.

Requirement for the immunoglobulin-like domain of granulocyte colony-stimulating factor receptor in formation of a 2:1 receptor-ligand complex

The extracellular portion of the granulocyte colony-stimulating factor (G-CSF) receptor has a mosaic structure of six domains (each approximately 100 amino acid residues) consisting of an immunoglobulin-like (Ig) domain, a cytokine receptor homologous region subdivided into amino-terminal (BN) and carboxyl-terminal (BC) domains, and three fibronectin type III repeats. In the present study, we expressed the Ig-BN and the BN-BC regions and purified them to homogeneity as monomers using G-CSF affinity column chromatography. Using gel filtration high performance liquid chromatography, we investigated the molecular composition of receptor-ligand complexes formed between G-CSF and purified BN-BC or Ig-BN domains. In contrast to the well characterized example of the human growth hormone (GH) receptor, in which the BN-BC.GH complex shows a 2:1 receptor-ligand complex stoichiometry, the BN-BC domain of the G-CSF receptor formed a 1:1 complex. The isolated Ig-BN domain also formed a 1:1 complex with G-CSF. However, in the presence of both Ig-BN and BN-BC domains, we detected a 1:1:1 Ig-BN.G-CSF.BN-BC complex corresponding to the 2:1 receptor: ligand stoichiometry. These results suggest that 1) the Ig domain and both the BN and the BC domains are required for oligomerization of the G-CSF receptor, 2) G-CSF contains two binding sites for its receptor, and 3) there are two ligand binding sites on the G-CSF receptor, one site on the BN-BC domain and one on the Ig-BN domain.

Convenient desktop-scale production of the extracellular domain of the human growth hormone receptor by an insect-baculovirus secretion system using a protein-free culture

Expression of a gene encoding the extracellular domain of the human growth hormone receptor (hGHR-ED) inserted into the genome of Autographa californica nuclear polyhedrosis virus was done using a desktop-scale spinner culture. Spodoptera frugiperda 9 (Sf9) cells infected with the recombinant virus secreted a protein with hGH-binding activity into the medium. Oxygen supplementation was required for high level secretion of the product. The highest cell production capability was estimated at more than 15 mg hGHR-ED/liter of culture. A protein-free medium supported the production similar to that obtained in traditional serum-containing media. This spinner culture system is simple to operate, and does not require expert knowledge of culture techniques.

[Anomalous origin of the right pulmonary artery from the ascending aorta: a case report]

We report a successful case of anomalous origin of the right pulmonary artery from the ascending aorta. A 34 days old infant, who had suffered from cardiogenic shock, underwent a direct anastomosis of the right pulmonary artery to the main pulmonary artery behind the ascending aorta under cardiopulmonary bypass. Postoperative catheterization showed no significant stenosis over the anastomosis and normalized pulmonary artery pressure. We conclude that early surgical correction is necessary in the treatment of this life threatening disease.

Can concordant criss-cross heart be ameliorated by hemodynamic changes?

A 2-year-old female child with "ameliorated" concordant criss-cross heart, complicated superior-inferior ventricles, complete transposition of great arteries, hypoplastic right ventricle, ventricular septal defect, and aortic coarctation is described. The patient underwent subclavian flap, pulmonary artery banding, and balloon atrioseptostomy at age 1 month. The ameliorated concordant criss-cross anatomy was obtained after 2 years of follow-up. This dynamic morphologic change allowed us to perform a subsequent anatomic correction.

Studies on neurovirulence in poliovirus-sensitive transgenic mice and cynomolgus monkeys for the different temperature-sensitive viruses derived from the Sabin type 3 virus

We have studied methods for testing the neurovirulence of live poliovaccine viruses by intraspinal inoculation into mice carrying the human poliovirus receptor gene (Tg mice). A comparison of the neurovirulence of Sabin type 3 vaccine virus and related viruses using the 50% paralysis dose determined after intraspinal inoculation into the Tg mice as an index revealed a close correlation between the results of the paralysis dose in Tg mice, the neurovirulence expressed by the histopathological lesions core in monkeys, and the temperature sensitivity of the viruses. The results of experiments in the Tg mice also showed a good correlation with the number of mutations at position 472 from U to C in the 5' noncoding region in the genomes of the viruses tested. These results strongly suggest that the neurovirulence test for oral poliomyelitis vaccine using the Tg mice is an excellent method and may be used in place of the test using monkeys.

[Anesthesia for removal of a large hepatoma under separated hepatic circulation]

A large hepatoma was removed under isolated hepatic perfusion. Hepatic circulation was separated from systemic circulation by clamping inferior vena cava, potal vein and hepatic artery. Lactated Ringer solution at 4 degrees C was perfused through potal vein, and disposed through the isolated part of inferior vena cava. Blood in proximal part of potal vein and right femoral vein was shunted to right axillary vein using a centrifugal pump. Prothrombin time and activated partial thromboplastin time were prolonged to more than 200 seconds and 300 seconds, respectively, 50 minutes after the commencement of isolated hepatic circulation. They recovered to normal ranges 115 minutes after the declamping, by injection of fresh frozen plasma. On clamping of the inferior vena cava, superior vena cava pressure was elevated and cardiac output decreased. When declamped, an excessive hemorrhage from the cross section of the liver was observed. It took 30 minutes for the systolic blood pressure to recover to 80 mmHg by rapid blood transfusion (150 ml.min-1). The hepatic perfusion with chilled lactated linger solution reduced the peripheral body temperature to 29 degrees C. Hypocalcemia, which was probably due to the massive blood transfusion, was treated with calcium gluconate and calcium chloride.

[Initial ultrafiltration to the priming solution with preserved blood for cardiopulmonary bypass in infants]

In case of open heart surgery in infants, the initial priming solutions (IPS) of the cardiopulmonary bypasses (CPB) include considerable amount of preserved blood to assure us of the proper hematocrit during the CPB. Aiming at elimination of unfavorable effects of preserved blood on hearts and vessels, the ultrafiltrations (UF) to the IPS before the beginnings of CPB had been carried out in 42 pediatric cases. The IPS amounted to 915 +/- 25 (mean +/- SE) ml. in which 581 +/- 31 ml of preserved blood were included. The 1.5-fold amount infusions over the IPS, consisted of 5% glucose, normal saline and fresh frozen plasma, were added to the IPS, and just the same amount fluid were removed out by the UF. The concentrations of potassium, NH3, lactic acid and pyruvic acid in the IPS decreased significantly after UF (p = 0.001). The potassium concentrations were compared among the blood of patients (PB), the IPS before UF (IPS1), the IPS after UF (IPS2), and the mixed blood drawn 5-10 minutes after the beginnings of CPB (MB) in the cases under the age of 1 year (group-I, n = 26, 4.7 +/- 0.3 kg) and in the elders (group-E, n = 16, 15 +/- 2 kg). The results showed all significant differences but "IPS2 and MB" in group-I, and but "PB and MB" in group-E (ANOVA p = 0.001, p < 0.01 by Newman-Keuls). The 98% of cases kept their innate heart beatings until the aortic clamps at 22 +/- 1 degrees C (sending blood temp.).(ABSTRACT TRUNCATED AT 250 WORDS)

Electrophoretic analysis of bile proteins from patients with and without gallstones

Bile proteins from 82 cases with various types of gallstones (pure cholesterol stones, cholesterol stones with a small amount of other substances, mixed stones and pigment stones) and 9 controls without gallstones were analyzed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE). A unique bile protein with a molecular mass of 32 kDa was identified. The 32 kDa protein could be stained on immunoblotting membranes using immunoperoxidase with concanavalin A. The 32 kDa protein was found in all controls but only in a portion (22.2-36.4%) of the patients with gallstones of various types. Following electrophoretic elution from the SDS-PAGE gels, the 32 kDa protein was analyzed by reversed phase--high-performance liquid chromatography, yielding three peaks for controls and only two peaks for patients with gallstones.

Neurovirulence test for oral live poliovaccines using poliovirus-sensitive transgenic mice

The transgenic mice, ICR-PVRTg21, carrying the human poliovirus receptor gene, were intraspinally inoculated with oral poliovirus vaccine viruses and the viruses that had been derived from a vaccine preparation by passagings at 38 degrees. Dose-dependent incidence of paralysis was observed in the transgenic mice inoculated with any of the viruses used. All transgenic mice showing histopathological lesions in the central nervous system appeared to display clinical signs that resembled those observed in human poliomyelitis. These suggest that relative neurovirulence levels of individual virus preparations can be estimated by values of 50% paralysis dose. Indeed, the parameter correlated well with monkey lesion scores of viruses used. Histopathological changes such as degeneration of neurons resemble those displayed by monkeys and were observed in the spinal cord, medulla oblongata, and pons. Thus, the transgenic mice, ICR-PVRTg21, may become a new animal model in place of monkeys for safety testing of oral poliovirus vaccine preparations.

Cytokeratin fragment 21-1 in gynecologic malignancy: comparison with cancer antigen 125 and squamous cell carcinoma-related antigen

We measured serum cytokeratin fragment 21-1 (CYFRA 21-1) levels by a solid-phase immunoradiometric assay in 102 healthy Japanese women, and set the reference value at 1.9 ng/ml (mean +2 SD of the serum levels based on a linear distribution). Pretreatment serum CYFRA 21-1 levels were also analyzed in 235 women with benign (n = 94) or malignant (n = 141) gynecologic disease, and were compared with the serum levels of CA 125 and SCC. The respective positivity rates for CYFRA 21-1 and CA 125 were 64.0 and 77.2% in ovarian malignancy, while they were 4.2 and 30.8% in benign ovarian masses. CYFRA 21-1 had an accuracy of 61.3% in diagnosing ovarian malignancy, which was higher than that of CA 125 (53.4%). The positive predictive value of CYFRA 21-1 for ovarian malignancy reached 94.1%, which was significantly (p < 0.005) higher than that of CA 125 (68.8%). These findings indicate the potential usefulness of CYFRA 21-1 as a tumor marker for ovarian malignancy. In addition, the positivity rates fo CYFRA 21-1 in cervical cancer (51.2%) and endometrial cancer (52.2%) were also similar to the respective rates for SCC and CA 125, which suggests that CYFRA 21-1 seems to be a general tumor marker for gynecologic malignancy.

Allogeneic peripheral blood stem cell transplantation for treatment of induction failure in a patient with Philadelphia chromosome-positive acute lymphoblastic leukemia

We report a successful case of allogeneic peripheral blood stem cell transplantation (PBSCT) for the treatment of primary induction failure in acute lymphoblastic leukemia (ALL). The patient was a 46-year-old male with Ph-positive ALL and failed to achieve complete remission (CR). His HLA genotypically identical brother refused to donate bone marrow. Instead, PBSCs were collected by apheresis from the brother after administration of G-CSF at a dose of 10 micrograms/kg. For allogeneic PBSCT, the patient was conditioned with marrow ablative chemotherapy and received the PBSC harvest containing 7.8 x 10(4)/kg of CFU-GM, 1.8 x 10(6)/kg of CD34-positive cells and 2.7 x 10(8)/kg of T lymphocytes. After transplant, the neutrophil count exceeded 0.5 x 10(9)/l on day 16 and the platelet count exceeded 20 x 10(9)/l on day 22. CR was confirmed with tri-lineage engraftment in bone marrow samples on days 28 and 49; disappearance of the Ph-chromosome was documented. Sustained engraftment was also confirmed cytogenetically using a variable number of tandem repeat (VNTR) markers. Acute graft-vs.-host disease did not develop with conventional prophylaxis of methotrexate and cyclosporine. However, on day 85 the patient developed leukemia relapse and died on day 97. This clinical trial suggests that allogeneic PBSCT may be an alternative to allogeneic bone marrow transplantation in some limited situations.

Evidence for the ligand-induced conversion from a dimer to a tetramer of the granulocyte colony-stimulating factor receptor

An extracellular portion of granulocyte colony-stimulating factor (G-CSF) receptor, which contains an immunoglobulin-like (Ig) domain and cytokine receptor homologous (CRH) region, was secreted into the medium using Trichoplusia ni-Autographa californica nuclear polyhedrosis virus system. The gene product was purified to homogeneity mainly as a dimer (85 kDa) using G-CSF affinity column chromatography and gel filtration HPLC, although the product existed as a monomer (45 kDa) in the medium. Scatchard analyses suggested that only the dimer had high affinity ligand binding (Kd = about 100 pM), which is comparable with the Kd value of the cell surface receptor. The binding of G-CSF to Ig-CRH induced its tetramerization (200-250 kDa). The molecular composition of the tetrameric complex showed a stoichiometry of four ligands bound to four Ig-CRH. These results suggested that the oligomeric mechanism of the G-CSF receptor differs from that reported for growth hormone (GH) receptor, although CD spectrum spectroscopy suggested that the Ig-CRH has a GH receptor-like structure.