[A phase 3 clinical trial of 123I-iomazenil, a new central-type benzodiazepine receptor imaging agent (Part 3)--Report on clinical usefulness in epilepsy]

A Phase 3 clinical trial of 123I-Iomazenil (IMZ), a tracer which binds specifically to central-type benzodiazepine receptors (BZR), was performed, and the clinical usefulness of IMZ was evaluated in 121 patients with epilepsy (106 cases with partial epilepsy and 15 cases with generalized epilepsy). A regional abnormality in the BZR distribution was detected in late IMZ images in 20 of 24 cases without abnormal MRI and/or X-ray CT findings. Moreover, only 16 of these 20 cases showed abnormal findings in the cerebral blood flow (CBF) images. In partial epilepsy, abnormal regions in late IMZ images agreed or partially agreed with epileptic foci estimated from the clinical symptoms of epileptic seizures, interictal EEG, and MRI and/or X-ray CT findings in 76%, 70% and 96% of the cases detected. These regions also agreed or partially agreed with the estimated epileptic foci in 92% of the cases with foci estimated by combination of those three methods and in 72% of those estimated by ictal EEG. The agreement or partial agreement rates of late IMZ images with each of the other methods were higher than those of CBF images, although the differences were not significant. For surgically-proven epileptic foci without any abnormality in the CBF image, abnormal regions were detected in late IMZ images. These findings suggest that IMZ SPECT is a useful new tool for detecting epileptic foci based on the distribution of BZR in the brain.

[A phase 3 clinical trial of 123I-iomazenil, a new central-type benzodiazepine receptor imaging agent (Part 4)--Report on clinical usefulness in diagnosis of cerebrovascular diseases]

Single photon emission computed tomography (SPECT) using 123I-Iomanzenil (IMZ), a tracer which binds specifically to central-type benzodiazepine receptors, was performed in patients with cerebrovascular diseases (CVD) to determine the clinical signicigance of IMZ SPECT studies in evaluating the pathophysiology of CVD. IMZ SPECT images obtained three hours after administration of the tracer were compared with the images of cerebral blood flow (CBF) studies in 206 cases. In regions with decreased CBF, the uptake of IMZ was relatively preserved in patients with cerebral thrombosis in comparison with cerebral embolism, and in those with perforator branch infarction in comparison with cortical infarction. The uptake of IMZ decreased as a function of both the severity of the decrease in the CBF and the duration of illness in regions with a significantly decreased perfusion reserve. These results suggest that decreased IMZ binding in ischemic stroke reflects the neuronal damage caused by the cerebral ischemia. On the other hand, in patients with intracerebral hemorrhage, the cortical uptake of IMZ was relatively well-preserved in regions with decreased CBF, and the decrease in the uptake of IMZ was more profound as a function of the decrease in the CBF, especially in cases of putaminal hemorrhage. These results also suggest that the decreased cortical CBF is a remote effect caused by a neuronal disconnection, and neuronal damage may occur in regions with severely impaired CBF.

[A phase 3 clinical trial of 123I-iomazenil, a new central-type benzodiazepine receptor imaging agent (Part 1)--report on clinical usefulness in diagnosis of various brain diseases]

Iomazenil (IMZ) is a partial inverse agonist of central-type benzodiazepine receptors (BZR) which binds specifically to BZR with high affinity. The safety and clinical effectiveness of 123I-IMZ SPECT in the diagnosis of brain diseases were evaluated in 655 patients with various brain diseases, such as epilepsy, cerebrovascular diseases, degenerative diseases and mental disorders relating to BZR. This was a Phase 3 study conducted as a multicenter trial at 52 collaborating institutions. There was no significant adverse reactions in the clinical symptoms or abnormal laboratory test values. The investigators judged 123I-IMZ SPECT to be effective in 95% of 638 analyzed cases. The injected dose did not correlate with the image quality or the clinical effectiveness of 123I-IMZ SPECT, suggesting that these items depend largely on the characteristics of the apparatus used, the disease or pathology of the patients, rather than the dose. We conclude that 123I-IMZ imaging is safe and provides effective information based on BZR binding which is useful in the diagnosis of various brain diseases.

[A phase 3 clinical trial of 123I-iomazenil, a new central-type benzodiazepine receptor imaging agent (Part 2)--Report on clinical usefulness in diagnosis of degenerative neurological diseases and mental disorders]

Iomazenil (IMZ) is a partial inverse agonist of central-type benzodiazepine receptors (BZR) which binds specifically to BZR with high affinity. A multi-center Phase 3 clinical study was performed to evaluate the clinical usefulness of 123I-IMZ-SPECT in the diagnosis of brain disorders in 169 patients with degenerative neurological diseases and 37 patients with mental disorders such as neurotic, stress-related and somatoform disorders. In dementia, the decrease in activity in late images, obtained three hours after administration of 123I-IMZ, correlated negatively with the dementia score. In Parkinson's disease and spinocerebellar degeneration. 123I-IMZ showed a more profound decrease in uptake in late images than seen in the cerebral blood flow (CBF) images, and this decrease was in proportion to the duration and severity of the illness. In mental disorders, the ratio of the late to early image counts showed a negative correlation with Hamilton's anxiety scale in all regions in the brain cortices. In panic disorders, the ratio of the cerebral count to the cerebellar count in the late images correlated negatively with the severity of the attack in the frontal, temporal and parietal cortices. These results suggest that 123I-IMZ-SPECT enables us to evaluate the neuronal damage in degenerative diseases and the decrease in the BZR binding potential in mental disorders.

[Oligospermia improved by switching an anticonvulsant from phenytoin to valproate]

We report a case of 30-year-old man with generalized seizure, who had received phenytoin (PHT) for more than 6 years, but developed decrease in sperm count and motility. After PHT had been discontinued and valproate (VPA) had been administered for 3 months, his sperm activity became normalized. The decrease in sperm motility was the most important cause of his infertility. Sperm motility has been reported to be inversely correlated with the ratio of the concentrations of antiepileptic drugs in the plasma and semen. In our case, the ratio was 0.21 for PHT and 0.08 for VPA. We wish to emphasize the importance of measuring the concentration of antiepileptic drugs in the semen of infertile young males if they are on anticonvulsants.

[Identification of neuronal death and DNA fragmentation in early stage after rat transient forebrain ischemia]

To clarify whether programmed cell death plays an important role in the delayed neuronal death after forebrain transient ischemia, we investigated the relationship between pathological changes visualized by HE staining and intranuclear DNA fragmentation evaluated by the TUNEL method in rat hippocampal CA1 pyramidal neurons at early times after the onset of transient forebrain ischemia. The investigations were carried out in male Wistar rats (N = 22) subjected to 20 minutes of transient forebrain ischemia by Pulsinelli's method. No morphological changes or TUNEL staining were observed at 1 hour after forebrain ischemia. HE staining revealed morphological changes in 8 +/- 4%, 10 +/- 4% and 88 +/- 9% of neurons in hippocampus CA1 at 3, 6 and 24 hours after forebrain ischemia, respectively at which times 0%, 74 +/- 1% and 68 +/- 11% of the neurons showed marked labeling with the TUNEL method. We therefore conclude that DNA fragmentation as evaluated by the TUNEL method is not involved in neuronal death, and no DNA fragmentation was detectable prior to morphological changes in the early stage of forebrain ischemia.

[An adult case of homocystinuria probably due to methylenetetrahydrofolate-reductase deficiency--treatment with folic acid and the course of coagulation-fibrinolysis parameters]

We report a rare male case of homocystinuria probably due to methylenetetrahydrofolate-reductase deficiency. The onset of his disorder was at 19 years of age, and he had no family history. He initially developed gait disturbance, and then generalized seizure in several months, which made him admitted to our hospital. Neurological examinations revealed mental dysfunction, spastic paraplegia, cerebellar ataxia, and sensory disturbance in his feet. MRI showed multiple increased intensities on T2-weighted images in the cerebral white matter. EMG revealed neurogenic changes. These symptoms and signs slowly progressed, and he then developed thrombophlebitis in his lower extremities. Thrombin-antithrombin III complex (TAT) and D-dimer remained high continuously, and plasma homocysteine level was more than ten times higher than the normal range. Plasma cystathionine level was high and methionine level was low. The serum folic acid, vitamin B12, and methylmalonic acid in the urine were normal. Megaloblastic anemia was not seen. Based on these data, he was diagnosed to have homocystinuria probably due to methylenetetrahydrofolate-reductase deficiency. Treatment with high doses of folic acid, pyridoxine and cobalamin normalized plasma cystathionine and methionine levels, and markedly decreased plasma homocysteine, although it remained about three times higher than the normal range. Thereafter, both TAT and D-dimer levels also markedly decreased. The administration of folic acid reduced elevated plasma homocysteine as well as the coagulation--fibrinolysis factors. This implies that they may serve as useful markers for effective treatment of this disease.

The defective secretion of a naturally occurring alpha-1-antichymotrypsin variant with a frameshift mutation

A newly found variant alpha-1-antichymotrypsin (ACT), ACT Isehara-2, has a deletion of two bases (AA) at codon 391 near the carboxyl terminus. This frameshift mutation caused a change in the amino acid sequence and generated 10 extra amino acids (408 amino acids total) [Tsuda, M., Sei, Y., Matsumoto, M., Kamiguchi, H., Yamamoto, Y., Shinohara, Y., Igarashi, T. & Yamamura, M. (1992) Hum. Genet. 91. 467-468]. The serum ACT levels in three unrelated heterozygotes with this mutant ACT gene were 37% 49% and 54% that of the normal individuals. To examine the reduced serum levels, the normal ACT and the mutant ACT created by site-directed mutagenesis were transfected into COS-7 cells for comparison. The value for the retention rate (intracellular ACT/total ACT) was apparently higher in the cells expressing mutant ACT Isehara-2 than those bearing the normal gene. In the pulse-chase experiments, the secretion of the synthesized mutant ACT into the medium was not observed, whereas the normal ACT was mostly secreted as a 64-kDa form. The endoglycosidase H digestion and an electron microscopic analysis indicated that the retained mutant ACT was present in the endoplasmic reticulum. These results provide the biochemical basis for the decreased serum ACT level of individuals with ACT Isehara-2, and suggest the importance of the carboxyl-terminal region for its secretion.

Changes in the cellular energy state affect the activity of the bacterial phosphotransferase system

The effect of different cellular free-energy states on the uptake of methyl alpha-D-glucopyranoside, an analogue of glucose, by the Escherichia coli phosphoenolpyruvate:carbohydrate phosphotransferase system was investigated. The intracellular [ATP]/[ADP] ratio was varied by changing the expression of the atp operon, which codes for the H+-ATPase, or by adding an uncoupler of oxidative phosphorylation or an inhibitor of respiration. Corresponding initial phosphotransferase uptake rates were determined using an improved uptake assay that works with growing cells in steady state. The results show that the initial uptake rate was decreased under conditions of lowered intracellular [ATP]/[ADP] ratios, irrespective of which method was used to change the cellular energy state. When either the expression of the atp operon was changed or 2,4-dinitrophenol was added to wild-type cells, the relationship between initial phosphotransferase uptake rate and the logarithm of the [ATP]/[ADP] ratio was approximately linear. These results suggest that the cellular free-energy state, as reflected in the intracellular [ATPI]/[ADP] ratio, plays an important role in regulating the activity of the phosphotransferase system.

Sialolithiasis in children: report of four cases

Sialolithiasis in children is rare. Four cases of sialolithiasis in the submandibular gland occurring in children < or = 10 years old are reported. True and distal oblique occlusal radiographs were found to be useful for detection of the sialolith. A review of the literature on sialolithiasis in children is presented.

Direct quantitative analysis of respirable cristobalite on filter by infrared spectrophotometry

A direct on-filter method in infrared spectrophotometry was investigated for the quantitative analysis of respirable cristobalite. A polypropylene membrane filter was employed for this analysis, because the membrane filter has high transparency and no interference peak in the spectral range to be used (750-250 cm-1). Linear relation between the sample weight and peak height (absorbance) for three specific peaks at 620, 385 and 300 cm-1 of cristobalite were confirmed over the range from 45 to 1,000 micrograms/cm2 for 620 cm-1 peak and 45-2,380 micrograms/cm2 for 385 and 300 cm-1 peaks. The variation of absorbance with the difference of particle size was smaller in filter sample than in potassium bromide pellet sample. As a conclusion, this direct on-filter method can be used for quantitative analysis of cristobalite in airborne dust in working environment.

A new approach to determine the effect of mismatches on kinetic parameters in DNA hybridization using an optical biosensor

We have demonstrated a simple yet direct method for determining the kinetic parameters in DNA-DNA interactions using biosensor technology based on the surface plasmon resonance phenomenon; a technique that does not require complex DNA labeling. To determine the effect of mismatches on the kinetics involved in DNA-DNA interactions, DNA hybridization kinetics were monitored in real time using synthetic oligonucleotides less than 20 bases in length which contained either a complementary sequence or mismatched bases. Upon analysis of the kinetic parameters obtained in oligonucleotide hybridization, we found that they were significantly affected by the presence of mismatches as well as by their number and location in a DNA duplex. In addition, the presented biosensor method is sensitive enough to detect kinetic effects caused by the presence of a single-mismatched base pair. Our findings strongly suggest that analysis of kinetic parameters involved in DNA-DNA interactions is advantageous for detecting the presence of mismatch base pairs in a DNA duplex.

Translocation of loops regulates transport activity of mitochondrial ADP/ATP carrier deduced from formation of a specific intermolecular disulfide bridge catalyzed by copper-o-phenanthroline

The cross-linking reagent copper-o-phenanthroline complex (Cu(OP)2) specifically caused a decrease in the amount of the 30-kDa ADP/ATP carrier in bovine submitochondrial particles associated predominantly with formation of a 60-kDa protein consisting of a cross-linked dimer of the carrier. However, Cu(OP)2 had no effect on mitochondria. The transport of ADP via the carrier through submitochondrial particle membranes was found to be inhibited in parallel with the progress of intermolecular cross-linking. Analysis of the cross-linked site showed that a disulfide bridge was formed only between two Cys56 residues in a pair of the first loops facing the matrix space. The transport inhibitor bongkrekic acid, which locks the m-state conformation of the carrier, had no effect on disulfide bridge formation catalyzed by Cu(OP)2, but carboxyatractyloside, which locks the c-state conformation by acting from the cytosolic side, completely inhibited the cross-linking. These results show that the ADP/ATP carrier functions as a dimer form, and a pair of the first loops protrudes into the matrix space in the m-state, but possibly intrudes into the membrane in the c-state. Thus, it is suggested that a pair of the first loops acts as a gate and that its opening and closing are regulated by their translocation.

A novel action of epidermal growth factor in rat granulosa cells: its potentiation of gonadotrophin action

It is well known that epidermal growth factor (EGF) induces down-regulation of LH receptors and desensitization to gonadotrophin stimulation in gonadal cells, including granulosa cells. In a previous study we showed that EGF receptor levels in rat granulosa cells were increased up to fourfold after 96 h of culture with human GH in the presence of FSH, and the present study has evaluated the action of EGF on these cells. The induced EGF receptors were identical in size to the pre-existing receptors as assessed by affinity labelling with 125I-EGF. After 48 h in culture, various amounts of EGF (0.5-10 ng) were added and the cells were cultured for a further 48 h. The addition of EGF caused down-regulation of LH receptors in cells expressing high levels of EGF receptors. However, this down-regulation was less than that in control cells. After the cells were washed, cAMP synthesis in response to human chorionic gonadotrophin (hCG) increased by two to three times the control value and this increase was closely correlated with an increase in EGF receptor content. However, stimulation with cholera toxin or forskolin showed no such augmentation, indicating that it may not be due to quantitative alterations in G proteins and their effector systems. Induction of EGF potentiation required long-term exposure to EGF, for at least more than 24 h. In addition, progesterone synthesis was sensitive to stimulation with lower doses of hCG. These findings indicate that the activation of hGH-induced EGF receptors may potentiate gonadotrophin action in granulosa cells.

[Two cases of micrognathia caused by radiation therapy during infancy: an evaluation of their profilograms]

Two patients with micrognathia of the mandible caused by radiation therapy during infancy are reported herein. The first patient was a 25-year-old man with hemangioma of the tongue. He had previously received radiation therapy totaling 51 Gy at 1 and 2 years of age. The other patient was a 54-year-old woman who had received radiation therapy for an oral tumor during infancy. These two patients demonstrated micrognathia, and the former patient showed developmental anomaly of the teeth. In addition, the latter patient suffered from thyroid cancer at 45 years of age, and this was also thought to be radiation-related. Although reports of micrognathia caused by radiation are rare, such late effects should be taken into account when radiation therapy is planned for head and neck tumors in infants.

A randomized trial of E5510 versus aspirin in patients with transient ischemic attacks. The Japanese E5510 TIA study-1 (JETS-1) Group

In a randomized double-blind trial, the Study Group compared the efficacy of E5510, a novel antiplatelet agent, and aspirin in preventing the recurrence of transient ischemic attacks (TIA). In total, 227 patients who suffered from TIA in the twelve weeks prior to the study were enrolled. They were randomly allocated to three treatment groups, ie, 71 patients in the E5510 4 mg group, 77 patients in the E5510 2 mg group, and 79 patients in the aspirin 324 mg group, and were treated for twelve to twenty-four weeks. The incidence of recurrent TIA or stroke was 21.5% in the aspirin group and was significantly lower in the E5510 groups, being 8.5% in the 4 mg group (P < 0.05) and 11.7% in the 2 mg group (P < 0.05). Adverse events were observed in 5 cases in the 4 mg group, in 8 cases in the 2 mg group, and in 10 cases in the aspirin group, but none of them were serious. Since safety was judged to be comparable among the three groups, E5510 appears to be an antiplatelet agent for the treatment of TIA with a clinical benefit over aspirin.

[Primary pulmonary amyloidosis with multiple nodules]

A 42-year-old man complained of a productive cough and exertional dyspnea. Roentgenogram and computed tomography of the chest showed several nodular shadows, and an open lung biopsy was done. Congo-red staining and electron microscopy showed the pulmonary nodules to be amyloid with infiltration by plasma cells and foreign body giant cells. The amyloid was identified as AL-lambda and kappa type by immunohistochemical examination, and plasma cells and foreign body giant cells contained light chains. In situ hybridization studies showed intens signals of lambda mRNA and kappa mRNA in the plasma cells, but no signal in the foreign body giant cells. The foreign body giant cells appeared to have phogocytosed the light chains. Electron microscopic examination showed an "amyloid star" in the foreign body giant cells. Morphologically, this observation showed that the amyloid was produced by the foreign body giant cells.

Right hepatic lobe agenesis associated with bile duct carcinoma

A patient with obstructive jaundice was found to have bile duct carcinoma and right hepatic lobe agenesis. The diagnosis was made by computed tomography (CT), cholangiography, and angiography. Right hepatic lobe agenesis is a rare anomaly and has never been previously reported with bile duct carcinoma. CT cholangiography was critical in diagnosing the morphologic anomalies of the bile duct in this case.

A selective N-type calcium channel antagonist reduces extracellular glutamate release and infarct volume in focal cerebral ischemia

Although a number of studies have demonstrated the neuroprotective effects of antagonists of postsynaptic N-methyl-D-aspartate (NMDA) and non-NMDA receptors in cerebral ischemia, little is known about the treatment of cerebral infarction through presynaptic blocking of extracellular glutamate release. We evaluated the effects of a presynaptic selective N-type calcium channel antagonist (SNX-111, given intravenously by continuous infusion at 5 mg/kg/h from 20 min prior to occlusion until 2 h postocclusion) on blood flow, extracellular glutamate, and infarct volume in rats with permanent occlusions of the right middle cerebral and right common carotid arteries plus 1-h transient occlusion of the left common carotid artery. There was no significant difference in CBF in the occluded cortex during the experiment between the treated and vehicle groups. SNX-111 significantly reduced total amount of extracellular glutamate during the experiment and the peak value of the glutamate after occlusion from 44.2 +/- 15.8 microM (mean +/- SD) to 21.4 +/- 11.4 microM (p < 0.01). Infusion of SNX-111 also significantly reduced the cortical volume of infarction from 47.2 +/- 5.8 to 19.9 +/- 7.3% (p < 0.0001). These results suggest that SNX-111 has a protective effect against focal ischemia through the inhibition of glutamate release from presynaptic sites, although SNX-111 may also affect the release of other neurotransmitters.

[A case of Guillain-Barré syndrome associated with anti-GM2 antibody due to cytomegalovirus infection--special reference to the effect of ganciclovir]

We report a case of Guillain-Barré syndrome (GBS) associated with anti-GM2 antibody caused by cytomegalovirus (CMV) infection. A 27-year-old man was admitted to our hospital because of muscle weakness in all his extremities. He had no background of immunological abnormalities. Within 5 days, generalized muscular weakness had progressed so rapidly that he suffered respiratory dysfunction and dysphagia. Throughout the entire clinical course, enzyme immunoassay (serum) and enzyme-linked immunosorbent assay (CSF) for CMV were carried out serially. Only antibodies against CMV were elevated during the clinical course in the serum and CSF. These findings supported the idea that he had developed GBS due to isolated CMV infection. We examined the reactivity of GBS sera with crude ganglioside fraction, and only anti-GM2 antibody was recognized on a high-performance thin-layer chromatogram plate in this case. Although the anti-GM2 antibody was decreased transiently by plasmapheresis, the clinical symptoms progressed. The symptoms advanced very rapidly during high-dose gammaglobulin therapy associated with reelevation of the anti-GM2 antibody. Following ganciclovir administration, however, the symptoms became diminished within 7 days and the anti-GM2 antibody fell dramatically. We speculate that the reason for the observed effectiveness of ganciclovir was direct suppression of activation of CMV, followed by the inhibition of the production of demyelinating antibodies including the anti-GM2 antibody.

Use of a biosensor based on surface plasmon resonance and biotinyl glycans for analysis of sugar binding specificities of lectins

We have developed a new method for analysis of the interaction between lectins and biotin-derivatized oligosaccharides involving a biosensor based on surface plasmon resonance. Complex type asialo-bi-, tri-, and tetra-antennary oligosaccharides were quantitatively converted into their biotin derivatives by incubating them with 6-(D-biotinyl)-aminohexanoyl hydrazide. This method was also applicable to sialyl sugar chains without any removal of sialic acid residues. The reaction mixture could be directly injected onto the streptavidin pre-immobilized surface of a sensor chip without any purification because of its fairly low reagent/carbohydrate molar ratio. The amounts of sugar chains required for interaction analysis by this method were as low as 1 pmol. The binding specificities of Sambucus sieboldiana lectin, Maackia amurensis lectin, Ricinus communis agglutinin-120 (RCA120), and concanavalin A could be rapidly determined qualitatively by this method. Furthermore, kinetic analysis of the interaction between RCA120, and complex type asialo-bi-, tri-, and tetra-antennary oligosaccharides revealed that both the association rate constant and the dissociation rate constant (kdiss) decreased with increasing numbers of terminal galactosyl residues. Because the tendency observed for kdiss paralleled the elution order of these oligosaccharides on RCA120 immobilized affinity chromatography, kiss might hold the key to determination of the elution order on affinity chromatography.

High expression of a novel carnitine palmitoyltransferase I like protein in rat brown adipose tissue and heart: isolation and characterization of its cDNA clone

To characterize energy metabolism in rat brown adipose tissue (BAT), we carried out differential screening of a cDNA library of BAT with a cDNA probe of white adipose tissue (WAT) and isolated one cDNA clone. It contained a single open reading frame of 2,316 bases which encodes a protein of 88.2 kDa. The predicted amino acid sequence showed the highest homology (62.6%) with that of rat carnitine palmitoyltransferase I (CPTI). The transcript corresponding to this cDNA was found to be abundantly expressed in BAT and heart. Therefore, the isolated clone is concluded to encode a CPTI like protein expressed in BAT and heart.

Stabilities of the fluorescent SH-reagent eosin-5-maleimide and its adducts with sulfhydryl compounds

The stabilities of the SH-reagent eosin-5-maleimide (EMA) and its adducts with the SH-compounds L-cysteine, N-acetyl-L-cysteine and glutathione (reduced form) were studied under various conditions in comparison with those of the adducts of N-ethylmaleimide (NEM). Studies by reversed-phase high performance liquid chromatography and mass spectrometry showed that EMA was less stable than NEM at neutral and moderately alkaline pH values. EMA formed a succinimide-type adduct with SH-compounds, and then underwent further modification by nucleophilic attack of OH- or an amino group. The succinimide-type adducts with acetylcysteine and glutathione were converted to open-type adducts, in which the succinimide ring was cleaved, whereas the adduct with cysteine was modified to a thiazine-type adduct. Kinetic analyses showed that these open-type and thiazine-type adducts were readily formed and were stable at moderately alkaline pH values such as pH 8.0 or 9.0.