Erythema nodosum-like eruption in sarcoidosis

Two cases of sarcoidosis with tender, erythematous nodules on the legs are reported. The cutaneous lesions were clinically similar to those of erythema nodosum, but histologically showed non-caseating epithelioid granulomas. A review of 14 cases of this particular sarcoid eruption reported in Japan showed that 13 had ocular involvement as in our cases. In the light of the high frequency of ocular involvement, a skin biopsy should be considered in patients presenting with erythema nodosum-like eruptions situated on the legs.

[Growth inhibition of the emulsion from to Brucea javanica cultured human carcinoma cells]

We studied the growth inhibitory activity of the emulsion from Brucea javanica fruit of B. javanica to human squamous cell carcinoma cells. The dose of 250 micrograms/ml at 96 hrs after drug exposure, it showed 42% growth inhibition, and at 500 micrograms/ml inhibited 56% of the cell growth. The effect of more than 50% of the growth inhibition was evident at more than 7 hrs after drug exposure. In the analysis of mechanism of the drug using a flow cytometry, the arrest in G1 phase of cell cycle was found during incubation of cancer cells with drug. These results suggested that the oil of B. javanica is useful as an anticancer drug.

Soluble interleukin-2 receptor in blood from patients with sarcoidosis and idiopathic pulmonary fibrosis

Soluble interleukin-2 receptor (sIL-2R) concentration is considered to reflect disease activity in patients with sarcoidosis. However, it remains to be evaluated whether or not the sIL-2R concentration reflects the total burden of granulomatous lesions, or if it can be a useful marker for other interstitial lung diseases such as IPF, the lesions of which are restricted to the lungs. In this study, we demonstrated that sIL-2R concentrations in 16 patients with active sarcoidosis increased (2031 +/- 1222 U/ml), compared to those in 29 patients with inactive disease (796 +/- 313), 24 with IPF (859 +/- 694) and 33 healthy controls (467 +/- 174). sIL-2R concentrations in patients with IPF also increased, more than those in healthy subjects. sIL-2R concentrations in 10 patients with extrathoracic lesions (ETL) were not different from those in 6 patients without ETL. Correlation between serum sIL-2R concentrations and serum ACE activity, BAL macrophage %, and BAL lymphocyte % was shown in patients with sarcoidosis. In patients with IPF, a correlation between sIL-2R concentrations and BAL macrophage % was found but there was no correlation between sIL-2R concentrations and BAL lymphocyte %. In conclusion, serum sIL-2R concentrations seem to reflect total inflammatory lesions. In addition, they reflect total inflammatory lesions of the lungs in sarcoidosis and IPF. For clinical purposes, its measurement may be more useful than that of BAL fluid concentrations in patients with sarcoidosis and IPF.

Determination of trace amounts of albumin in human bronchoalveolar lavage fluids by fluorometry with chromazurol S

Fluorometry using chromazurole S (CAS) was applied to determine trace amounts of albumin in human bronchoalveolar lavage fluids (BALF). The calibration curve was linear in the range of 5-60 micrograms/ml of albumin. The CAS method was proven to be much more selective for albumin than for IgG. Freezing of BALF samples did not affect albumin analysis by the CAS method after storage at -20 degrees C for 80 days. This finding suggests that albumin in the BALF samples is stable under these conditions. The correlation was highly linear (r = 0.966) between the albumin levels in concentrated BALF samples (n = 47) determined by the CAS method and by radial immunodiffusion. The CAS method is sensitive enough to determine albumin levels in unconcentrated BALF samples, whereas radial immunodiffusion often requires concentration. The former method is more suitable for measuring albumin in BALF samples than the latter, because concentration by ultrafiltration results in poor reproducibility. The concentration of albumin in BALF samples of healthy volunteers (n = 5) and patients with sarcoidosis (n = 32) was determined by the CAS method. There was a statistically significant difference (P < 0.01) in the albumin levels in BALF samples between healthy subjects and patients with sarcoidosis at a clinically active state (n = 15). This finding shows that the determination of albumin levels in BALF samples is useful for investigating lung diseases and that the CAS method is promising in the determination of trace albumin in BALF samples, because it is simple, sensitive and precise.

Immunocytochemical characterization of isolated human type II pneumocytes

The expression of surface antigens on human type II pneumocytes is unknown but may be important in diagnostic cytology of bronchoalveolar lavage specimens. Thus, the immunocytochemical reactivity of isolated human type II pneumocytes was determined using a panel of commercially available monoclonal antibodies (MAbs). Type II pneumocytes were isolated from fresh human lung tissue obtained from surgical specimens (four non-smokers, six heavy smokers) after enzymatic digestion with dispase and subsequent discontinuous metrizamide gradient centrifugation. MAbs OKIa; EMA; OKT9; BMA 130a, b and c; EP4; TAG 72; HEA 125; and Leu M1 were studied using the peroxidase-antiperoxidase adhesive slide assay method. In all cases, type II pneumocytes reacted positively with OKIa, BMA 130a, BMA 130b, EMA, EP4, TAG 72 and HEA 125 and negatively with OKT9, BMA 130c and Leu M1. The percentage of positively reacting type II pneumocytes was 90 for OKIa, HEA 125 and EP4; 80 for EMA; 50 for TAG 72 and BMA 130a; and 5 for BMA 130b. Human type II pneumocytes share the expression of several antigens with epithelial tumor cells. This limits the usefulness of these markers with respect to differentiating between reactive type II pneumocytes and malignant cells.

[Corticosteroid treatment to patients with sarcoidosis]

Regarding the corticosteroid treatment to patients with sarcoidosis, two schools of thoughts can be recognized: the one in favor of early treatment in contrast to the one preferring late treatment. However, no final consensus has been obtained so far. We analysed ten years follow-up data of patients with sarcoidosis who were detected by health examination though they were asymptomatic. The results showed that the rate of improvement of chest abnormality was higher in the non-treated cases than in the treated ones. The possibility exists that this can be applied to the cases with symptoms at detection. In conclusion, from the present state of knowledge, the use of corticosteroids is justified only for symptomatic relief and control of disabling systemic involvement.

Fluorescence in the migrating pseudoplasmodium of the cellular slime mold Dictyostelium mucoroides

Fluorescence was observed under light microscope in living cells and cell mass of Dictyostelium mucoroides. The fluorescence was localized in the vacuoles of live vegetative cells. While the cell mass of D. discoideum does not have a stalk during migration period, the cell mass of D. mucoroides has a stalk that forms at the beginning of the migration period. We were able to observe a preferential loss of the fluorescent vacuoles from the cells of the stalk and from the stalk-forming cells at the tip region of the slug. Although the fluorescence was also present in the mature spore mass of D. mucoroides, the fluorescence was not observed in the spores, but rather in the spaces between the spores within the spore mass. The fluorescent vacuoles in the cells of vegetative stage and of migrating slug stage may be related to the interspore fluorescence in the spore mass. Possible roles of the fluorescent substance(s) in amoebae, slugs and spore masses were discussed.

Differentiation of toxigenic from nontoxigenic isolates of Pasteurella multocida by PCR

A PCR assay was developed for the differentiation of toxigenic Pasteurella multocida subsp. multocida strains, the major etiologic agent for progressive atrophic rhinitis in pigs, from nontoxigenic strains. The PCR targeted a toxA gene encoding a 143-kDa dermonecrotic toxin that is considered to be the central etiologic factor in progressive atrophic rhinitis. toxA fragments were amplified from toxigenic P. multocida isolates but not from nontoxigenic isolates or other bacteria isolated from pigs. The sensitivity of the reaction was as low as 10 pg of chromosomal DNA from a toxigenic strain. The results obtained by PCR of the DNAs of 187 field isolates of P. multocida were consistent with those obtained by the guinea pig skin test and Western blot (immunoblot) analysis. Restriction fragment analysis of the PCR-amplified fragments from 67 field isolates and comparison of the DNA sequences of fragments from capsular serotype A and D strains suggest that the PCR-amplified region, which is considered to encode the major immunologic determinants of the toxin, would be the same among P. multocida strains. The PCR that we describe should be useful for the diagnosis and the etiologic survey of progressive atrophic rhinitis.

ICAM-1 and integrin expression on isolated human alveolar type II pneumocytes

Adhesion molecules are involved in the recruitment of leucocytes to sites of inflammation. In this study, we determined the expression of several adhesion molecules on isolated human alveolar type II pneumonocytes. Type II pneumocytes were isolated from 10 normal lung specimens, by enzymatic digestion with dispase, followed by metrizamide gradient centrifugation and panning on immunoglobulin G (IgG)-coated plastic dishes. With the freshly isolated type II cells, immunostaining was performed using a sensitive immunoperoxidase slide technique. In all cases, 60-90% of type II cells were positive for intercellular adhesion molecule-1 (ICAM-1) (CD54). A minor portion of type II cells expressed the alpha 4 (CD49d) subunit of the beta 1-integrins, and the alpha-v (CD51) subunit of the vitronectin receptor. CD11a, CD11b, CD11c, CD18, CD49b, and CD49f failed to demonstrate any immunostaining with type II cells. In conclusion, the observation of the expression of ICAM-1 and, to a lesser degree, of some integrin subunits, may indicate that alveolar type II cells participate in local immune and inflammatory responses.

TNF alpha mRNA, but not IL-1 beta, is differentially expressed in lung macrophages of patients with active pulmonary sarcoidosis

In pulmonary sarcoidosis or experimental granuloma formation, interleukin-1 beta (IL-1 beta) or tumor necrosis factor alpha (TNF alpha) seem to play important roles during the inflammatory process. In order to examine whether IL-1 beta or TNF alpha mRNA expression in lung macrophages relates to disease activity or clinical course, ten cases with pulmonary sarcoidosis were divided into two groups: five cases with disease duration of more than 10 years (14.6 +/- 4.4 yrs; group A), and 5 cases with a duration of less than 3 years (1.7 +/- 1.1 yrs; group B). All cases showed both abnormal chest X-rays and elevated serum angiotensin converting enzyme activities. We compared these ten cases with 12 healthy subjects (6 nonsmokers: NS and 6 current smokers: S), and 5 cases with idiopathic pulmonary fibrosis (IPF) as disease control. Lavage macrophages were purified using the rosette forming method followed by plastic adhesion for one hour. Thereafter, RNA was extracted according to the AGPC method and amplified by the reverse transcription-polymerase chain reaction (RT-PCR). The results showed that IL-1 beta mRNA was detected in all samples studied, but TNF alpha mRNA expression was different among the groups: 5/5 (100%) in group A, 1/5 (20%) in group B, 5/5 (100%) in IPF, and 12/12 (100%) in healthy subjects. A constitutive expression was seen in healthy controls. On the other hand, no detection of TNF alpha mRNA was shown in pulmonary sarcoidosis. This fact may relate to a spontaneous regression of inflammation in sarcoidosis, as a substantial number of cases in group B may in time regress spontaneously.

Pneumonitis associated with natural and recombinant interferon alfa therapy for chronic hepatitis C

We report three cases of chronic hepatitis C (HC) with pneumonitis, suspected to be caused by natural and recombinant interferon (INF) alfa treatments. The patients were administered INF through intramuscular injection. All three patients developed acute respiratory failure (PaO2 < or = 60 mm Hg) with bilateral lung infiltration. One of the patient's condition improved after the cessation of INF treatment, without any other therapy. The other two patients were administered corticosteroids, and one patient's condition improved, while in the other patient the pneumonitis persisted, even after a high dose of corticosteroids. To our knowledge, these three cases are the first report of pneumonitis associated with INF alfa in patients with chronic HC.

Differential effects of indomethacin and dexamethasone on cytokine production in carrageenin-induced rat pleurisy

The effect of anti-inflammatory drugs on cytokine production at local inflammatory sites was investigated in a carrageenin-induced rat pleurisy model. Exudate volume and leukocyte number in the pleural cavity at 3 h after the carrageenin injection were significantly reduced by the pretreatment with indomethacin or dexamethasone. Both drugs also reduced the prostaglandin E2 level in the exudate. However, production of tumor necrosis factor (TNF) and interleukin-1 in the pleural exudate was significantly enhanced by the pretreatment with indomethacin, whereas the interleukin-6 level was reduced. Pretreatment with dexamethasone markedly suppressed all these cytokine levels. When resident pleural cells were stimulated with lipopolysaccharide in vitro, the presence of exogenous prostaglandin E2 reduced the production of TNF and interleukin-1, while it increased that of interleukin-6 in a dose-dependent manner. These results suggest that prostaglandin E2 could be a regulating factor involved in cytokine production at the inflammatory site. Dexamethasone may express a direct suppressive action on cytokine production rather than an indirect regulatory action through prostaglandin E2 level.

Clubbing of the fingers and smooth-muscle proliferation in fibrotic changes in the lung in patients with idiopathic pulmonary fibrosis

In our study of 52 patients with idiopathic pulmonary fibrosis (IPF), we found that the incidence of clubbing of the fingers was significantly more frequent in male than in female patients and in patients who showed lesser grades of honeycombing and higher grades of smooth-muscle proliferation in the pulmonary fibrotic changes (p < 0.01). Smooth-muscle proliferation in fibrotic changes of open lung biopsy specimens correlated with the mode of detection of IPF and the presence of clubbing of the fingers, duration of symptoms of the lower respiratory tract, and a higher extent of pulmonary infiltrates on chest radiographs (p < 0.05). However, the presence of clubbing of the fingers or grades of smooth-muscle proliferation in the pulmonary fibrotic changes did not correlate with the 2-year survival after open lung biopsy.

Identification of an antigenic domain on Mycobacterium leprae protein antigen 85B, which is specifically recognized by antibodies from patients with leprosy

Sixty-three overlapping 15-oligomer peptides covering the 30-kDa protein antigen 85B of Mycobacterium leprae were tested by ELISA to identify epitopes recognized by human antibodies. Serum samples from patients with lepromatous leprosy (LL) reacted mainly with peptides comprising amino acid regions (AA) 206-230, 251-280, and 291-325. Sera of patients with active tuberculosis who responded to the native 30-kDa antigen did not recognize these peptides. The antibody-binding specificity to the defined B cell regions was evaluated in a blind study with 71 serum samples from patients and household contacts living in Ethiopia where leprosy is endemic. The peptide of AA 256-280 was recognized by 88% of LL patients, 15% of patients with tuberculoid leprosy, and none of the contacts. These findings suggest that there are major linear B cell epitopes on the M. leprae 30-kDa protein that are recognized by lepromin-negative LL patients, whereas lepromin-positive patients respond preferentially to conformational epitopes.

[Selection of patients with UIP for lung transplantation]

To select patients with UIP for lung transplantation, critical parameters that may indicate the prognosis after lung transplantation need to be found. We studied the course of disease of 53 cases of IPF which were diagnosed as UIP by open lung biopsy. We divided these cases into two groups: a decreased group in which the patients died due to the progression of the disease within two years after open lung biopsy, and a surviving group in which patients were still alive two years after biopsy. The comparative study revealed that there was no difference in symptomatic cases in the following parameters, the degree of the involved area on chest radiographs, a lower % VC and elevated LDH levels all related to the prognosis 2 years after open lung biopsy. However, there was no difference of the number of cases that satisfied all factors between the both groups. In conclusion, it is difficult to select recipients with IPF at an adequate stage for lung transplantation. Careful and intensive examination is required for selection of the recipients.

Growth inhibition of human gastrointestinal cancer xenograft lines by treatment with CPT-11 and VP-16

A water-soluble and stable camptothecin derivative, CPT-11, was found to possess a strong antitumor activity against various murine tumors. In the present study, CPT-11 was tested against ten human gastrointestinal cancer xenograft lines carried by nude mice. CPT-11 was very effective against nine xenograft lines, with the exception of one xenograft. On the other hand, VP-16 was ineffective against all these xenograft lines. Therefore, CPT-11 is expected to be clinically more effective against gastrointestinal cancer than the topo II targeting agent.

[Pathogenesis of idiopathic pulmonary fibrosis--is hepatitis C virus involved?]

Hepatitis C virus (HCV) is a new virus discovered in 1989. Since HCV is known to cause fibrotic changes in the liver, we studied whether HCV is involved in the pathogenesis of idiopathic pulmonary fibrosis (IPF). Firstly, we assessed anti-HCV antibodies by enzyme-linked immunosorbent assay (ELISA) in the sera obtained from 66 IPF patients (46 males and 20 females; mean age +/- SEM, 61.5 +/- 10.1). We observed a significantly high prevalence of anti-HCV antibodies in IPF compared with 9,464 age-matched controls (28.8% vs 3.66%, p < 0.05). To confirm the results, recombinant immunoblotting assay (RIBA) was conducted on the 19 ELISA-positive sera, and 8 sera (12.2%) were found to be definitely positive. Secondly, we searched for HCV in the blood of IPF patients by reverse transcription-polymerase chain reaction. As preliminary data, four out of 28 cases (14.3%), all of which were pathologically diagnosed as UIP, were positive for HCV. In conclusion, although further investigation is required, a high prevalence of anti-HCV antibodies and the existence of HCV itself in the blood may suggest the possibility that HCV infection plays an important role in the pathogenesis of IPF.

DNA sequence analysis of an allelic variant of the Actinobacillus pleuropneumoniae-RTX-toxin I (ApxIA) from serotype 10

The structural gene encoding Actinobacillus pleuropneumoniae-RTX-toxin I (ApxIA), one of the major hemolytic and cytolytic toxins of the organism, was cloned from serotype 10. The nucleotide sequence data showed that the gene from serotype 10 was 98% identical to that from serotype 1 at both DNA and amino acid levels. The sequence difference was found to localize at the 3' terminal region of the gene. We then analyzed the 3' terminal region of the apxIA gene from other serotypes, 5a, 5b, 9 and 11, using polymerase chain reaction-amplified DNA fragments. Results of DNA sequence indicated that apxIA gene can be divided into the original form including serotypes 1, 9 and 11, and the allelic variant including serotypes 5a, 5b and 10. These gene products, ApxIA proteins, appear to have different second structures at the carboxyl terminal proximal region.

Determination of human immunoglobulin A and secretory immunoglobulin A in bronchoalveolar lavage fluids by solid phase enzyme immunoassay

Solid phase enzyme immunoassay methods for the determination of secretory immunoglobulin A (IgA) and the total amount of serum and secretory IgA in bronchoalveolar lavage fluids (BALF) were developed. The solid phase was prepared by immobilizing rabbit anti-human IgA. Horseradish peroxidase-conjugated goat anti-secretory component or horseradish peroxidase-conjugated goat anti-human IgA (Fc) were used as labeled antibodies. The minimum detectable amounts of secretory IgA and total IgA were 2 and 0.5 ng/well, respectively. These assay methods were successfully applied to the determination of secretory and total IgA levels in BALF samples obtained from 44 subjects including healthy non-smokers, smokers and patients with the following lung diseases: idiopathic pulmonary fibrosis, sarcoidosis and hypersensitivity pneumonitis. The secretory and total IgA levels in BALF collected from healthy non-smokers (n = 9) were 10.5 +/- 3.6 and 25.4 +/- 15.5 (S.D.) micrograms/ml, respectively. In healthy smokers, the secretory IgA concentration was significantly decreased and in idiopathic pulmonary fibrosis, the total IgA was increased. These results indicate that the quantitation of secretory and total IgA may be useful for the investigation of lung disease.

[Quantitative evaluation of gene expression of IL-1 beta and IL-1 receptor antagonist (IL-1ra) from alveolar macrophages in idiopathic pulmonary fibrosis (IPF) and sarcoidosis]

Our previous studies demonstrated the concomitant release of IL-1 and IL-1ra in the culture supernatants of alveolar macrophages in both healthy subjects and patients with interstitial lung diseases. IL-1ra was decreased in healthy smokers (HS), IPF, and sarcoidosis, compared to healthy nonsmokers (HNS), although an increase in IL-1 release could not be detected. In this study, we examined whether such findings could be found at the gene level, or reflect posttranscriptional regulation in patients with IPF (n = 8), sarcoidosis (n = 7), healthy smokers (n = 6) and healthy nonsmokers (n = 5). The expression of IL-1 beta, IL-1ra and a house keeping gene (glucose 6 phosphate dehydrogenase: G6PD) was investigated using reverse transcription polymerase chain reaction (RT-PCR). After RT-PCR, analysis and quantification of PCR products were performed by high-performance liquid chromatography. We used 26 cycle for IL-1 beta and IL-ra mRNA and 29 for G6PD, because amplification of mRNA was in the exponential phase on that cycles, respectively. The results were expressed as the ratio of each mRNA to G6PD mRNA. IL-1ra/G6PD ratio in patients with IPF and sarcoidosis, was lower than that in HNS. On the other hand, IL-1 beta/G6PD ratio was similar in all groups. IL-1ra/IL-1 beta ratio was decreased in patients with IPF and sarcoidosis, compared to HNS. These results suggest that decreased expression of IL-1ra gene may contribute to the development of chronic low grade inflammation of the lung.

hlyIA-like sequence present in a genetic locus with low homology to appA in Actinobacillus pleuropneumoniae serotype 10

Using the appA gene encoding Actinobacillus pleuropneumoniae-RTX-toxin II (ApxII) as a probe, Southern hybridization demonstrated the presence of appA-sequence in all 12 serotypes except serotype 10. Serotype 10 strains had a genetic locus with low homology to appA (tentatively designated Lha). DNA sequence analysis revealed that Lha contained a part of hlyIA gene encoding a 105-kDa hemolysin ApxI. Southern hybridization demonstrated the presence of Lha (hlyIA) sequence not only in serotype 10 but also in serotypes 1, 5a, 5b, 9, and 11, which had strong hemolytic activity with sheep red blood cells and were highly virulent for mice. These results suggest that ApxI may be associated with the virulence phenotype of the organism.

The diagnostic accuracy of high-resolution computed tomography in diffuse infiltrative lung diseases

The purpose of this study was to evaluate the role of high-resolution computed tomography (HRCT) in the clinical diagnosis of diffuse infiltrative lung disease (DILD). Diagnostic accuracy was compared using both chest radiography and HRCT. One hundred thirty-four cases of DILD, representing 21 different diseases, were selected for study, and the disease state was confirmed either histologically or microbiologically. The HRCT images and chest radiographs, available in all cases, were reviewed separately and in random order by 20 physicians who were provided only with information on each patient's age and sex. Overall, a correct first-choice diagnosis was made in 38 percent using radiographs and in 46 percent using HRCT images (p < 0.01). The correct diagnosis was among the top three choices in 49 percent when chest radiographs were used, and in 59 percent when HRCT images were viewed (p < 0.01). The correct first-choice diagnosis increased remarkably when the HRCT was used in usual interstitial pneumonia, sarcoidosis, alveolar proteinosis, bronchiolitis obliterans organizing pneumonia, hypersensitivity pneumonitis, and pulmonary lymphangiomyomatosis. High-resolution computed tomography was confirmed to be superior to conventional radiography in the accurate diagnosis of DILD in clinical practice.