Prolongation of serum half-life of interleukin 2 and augmentation of lymphokine-activated killer cell activity by pepstatin in mice

We reported previously using a murine model that the kidney is the organ involved in catabolism of exogenous human recombinant interleukin 2 (IL-2) and that cathepsin D, a major renal acid protease, is responsible for the degradation of IL-2. In the present report also using BALB/c mice we have investigated the effect of in vivo pepstatin, an acid protease inhibitor, treatment on serum half-life of IL-2, and generation of lymphokine-activated killer (LAK) cell activity. The in vivo pepstatin treatment by i.p. injection resulted in a significant reduction in the accumulation of 125I-IL-2 by the kidney in a reverse dose-response manner. Pepstatin treatment prolonged the serum half-life of 125I-IL-2, and the increase in serum half-life of 125I-IL-2 was pepstatin dose dependent. A significant reduction in renal cathepsin D activity, as monitored by the degradation of 125I-IL-2, was detected. In vivo pepstatin (0.6 mg/kg) treatment along with IL-2 (300,000 IU/mouse) daily for 3 or 6 days resulted in an augmentation of natural killer activity exhibited by freshly prepared and uncultured splenocytes against YAC-1 cells. An additional culturing of the splenocytes with IL-2 (3,000 IU/ml) in vitro for 1 day significantly enhanced the effect of in vivo pepstatin treatment; i.e., LAK cell activity generated from the splenocytes of animals treated with IL-2 plus pepstatin was greatly augmented in comparison with that treated with IL-2 alone. Phenotypic assessment by cell surface markers (Thy-1.2, Lyt-2, L3T4, and asialo-GM1) on the fresh splenocytes prepared from animals treated in vivo with pepstatin plus IL-2 revealed a decrease in the percentage of cells expressing Thy-1.2 and Lyt-2 and an increase in those carrying asialo-GM1. These results demonstrated that, as a result of in vivo pepstatin treatment, renal cathepsin D activity was greatly inhibited, which in turn reduced the degradation of circulating IL-2, then prolonged serum half-life of IL-2, and subsequently augmented natural killer and LAK cell activity. The in vivo pepstatin and IL-2 treatment decreased the T-cells and increased the natural killer-like LAK precursor cells, possibly also with an increase in its activity, which were further induced by in vitro IL-2 culture to generate an augmented LAK cell activity. This study also suggests the clinical potential of pepstatin in IL-2-related immunotherapy.

Effects of intraperitoneal transplantation of microcarrier-attached hepatocytes on D-galactosamine-induced acute liver failure in rats

A study was conducted to investigate morphologic as well as metabolic characteristics of microcarrier-attached hepatocytes in culture, and also to evaluate the effect of intraperitoneal transplantation of the microcarrier-attached hepatocytes on acute hepatic failure in rats induced by D-galactosamine (GalN). Rat hepatocytes were isolated by collagenase perfusion, and cultured on collagen-coated microcarriers. Protein synthesis estimated by [14C] leucine incorporation was four-fold higher in microcarrier culture than in cell suspension. The rates of albumin, transthyretin and bile acid syntheses in hepatocytes cultured on microcarriers were similar to those in monolayer culture. When microcarrier-attached hepatocytes were intraperitoneally transplanted into rats with Galn-induced acute liver failure, a marked improvement in survival rate was observed as compared with control rats which received injections of microcarriers alone (80% vs 0% beyond 6 days of transplantation). Mean serum glutamate oxaloacetate transaminase (SGOT), serum glutamate pyruvate transaminase (SGPT), methionine and glucose levels were similar in both groups, while serum bilirubin and ammonia levels were lower (P less than 0.1, P less than 0.05) in rats transplanted with the microcarrier-attached hepatocytes. Immunohistochemical examinations revealed that the transplanted hepatocytes around microcarriers had albumin synthesis activity, whereas almost no albumin synthesis was demonstrated in recipient liver. In conclusion, intraperitoneal transplantation of the microcarrier-attached hepatocytes will provide sufficient metabolic support, representing detoxication of ammonia (and presumably bilirubin) and synthesis of albumin, to allow GalN-damaged liver function to restore. Microcarrier culture of isolated hepatocytes seems to be one of the most appropriate tools for an artificial liver support.

Anti-hepatitis C virus antibody prevails in fulminant hepatic failure

Serial serum samples obtained from 27 patients with fulminant hepatic failure (FHF) in a variety of etiology were tested for anti-hepatitis C virus antibody (anti-HCV). Seven out of 10 patients (70%) with FHF due to hepatitis B virus (HBV) infection were positive for anti-HCV, showing a significantly higher rate than that in acute HBV hepatitis (0/17, 0%): In particular, all 3 post-transfusion HBV-FHF cases were found to be positive for the antibody. The incidence of anti-HCV in sporadic non-A non-B (NANB)-FHF patients (7/11, 64%) tended to be greater than that in acute sporadic NANB hepatitis as recently surveyed in this country. In addition, anti-HCV was also detected in a patient with hepatitis A virus (HAV)-FHF and in 2 out of 4 drug-induced FHF patients. Moreover, anti-HCV appeared earlier in FHF (median; 27.5 days, n = 9) regardless of etiology, when compared to acute NANB hepatitis (3 to 6 months). Hence, co-infection and/or superinfection of HCV with enhanced antibody response may play an important role in the development of this fatal disease.

p75c-myb expression in leukemia-lymphoma cells correlated with proliferation and differentiation

Monoclonal antibodies (McAbs) against a part of v-myb gene product were prepared for the detection of human c-myb gene product (p75c-myb). Western blotting analyses with these McAbs were performed on human leukemia-lymphoma cells. All T-cell lines were positive in p75c-myb expression. B-cell lines were variable, myeloid and erythroid cells were positive although the amount of expressed p75c-myb was less than the T-cell lines. Cells isolated from patients were positive in expression except for cells from acute myeloblastic leukemia with maturation (AML M2), acute hypergranular promyelocytic leukemia (AML M3) and erythroleukemia (AML M6) developed from myelodysplastic syndromes. Differences in p75c-myb expression seemed to depend upon the differentiation stage and distinctive lineage from which each cell line had been established. The p75c-myb expression in HL60 (acute promyelocytic leukemia cell line) showed remarkably high at logarithmic growth. When examined with HL60, p75c-myb expression significantly decreased during the differentiation induced by 12-O-tetradecanoylphorbol-13-acetate or retinoic acid. These results suggest that p75c-myb expression plays a crucial role in hematopoietic cell proliferation and differentiation and that multiple mechanisms including aberrant expression of p75c-myb is involved in leukemogenesis.

Effects of the antisense v-myb' expression on K562 human leukemia cell proliferation and differentiation

Recombinant plasmids containing v-myb' (803 bp fragment of the 3' end of v-myb) were constructed to induce sense or antisense v-myb' RNA expression with dexamethasone in human cells. These plasmids were used as a tool for the investigation of the role of c-myb gene in human leukemia cell proliferation and differentiation. They were transfected by electroporation into the K562 human leukemia cell line derived from a patient with chronic myelogenous leukemia in blastic crisis. After induction of transcription by dexamethasone, the plasmid with antisense v-myb' repressed the expression of p75c-myb from the endogenous c-myb gene of K562 cells. It also reduced the proliferation rate of K562 cells to 50% of the control level, and induced these K562 cells to express the myelomonocytic differentiation cell surface marker CD13 and increased NBT reducing activity. The plasmid with sense v-myb' did not have an effect on p75c-myb expression, the proliferation of K562 cells or the expression of myelomonocytic differentiation phenotypes. These observations suggest that antisense v-myb' RNA represses p75c-myb expression and that a decrease of p75c-myb suppresses K562 cell proliferation and induces its differentiation towards the myelomonocytic lineage.

[Study of surgical resection of sternal metastasis from carcinoma of the breast]

Three patients with a sternal metastasis from a carcinoma of the breast were treated with a partial resection of their sternum . Two patients died 13 and 14 months after their sternectomy. The remaining patients, however, has survived without a subsequent metastasis for 7 years. The sternal metastasis in the 7-year survival case was confined to the sternum for 7 months before the metastatic resection. Thus, a sternectomy, followed by chemo-endocrine therapy for several months may be indicated for patients with a solitary sternal metastasis, if there is no evidence of a systemic spread.

Kaolin-induced writhing in mice, a new model of possible bradykinin-induced pain for assessment of analgesic agents

Kaolin induced a clear and reproducible writhing reaction when intraperitoneally injected into mice. A simultaneous injection (i.p.) of soybean trypsin inhibitor (SBTI) significantly suppressed the kaolin-induced writhing reaction. This writhing reaction was markedly potentiated by a simultaneous injection (i.p.) of captopril. In an in vitro experiment kaolin caused kinin-release in mouse plasma, possibly through the activation of prekallikrein. This activation of plasma prekallikrein and kinin-release were inhibited in the presence of SBTI. Some non-steroidal anti-inflammatory agents inhibited the kaolin-induced writhing reaction dose-dependently. These results suggest that kaolin-induced writhing reaction may be caused by the released bradykinin through activation of the plasma kallikrein-kinin system. This model is a novel and simple tool for assessment of analgesic agents.

[Basic analysis of extracorporeal shock wave lithotripsy of gallstones]

Influence of extracorporeal shock wave lithotripsy (ESWL) on human gallstones placed in dog gallbladders was investigated. After irradiation of shock wave more than 600 times, maximal diameter of residual stones of 10 mm before irradiation was destroyed to 2 mm or less. Levels of serum transaminase (GOT.GPT) were elevated, in parallel with times of shock waves. These results suggested that 600 times of shock waves were enough to destroy one cholesterol stone, diameter of which was about 1 cm. Data of elevation of serum transaminase showed that more than 600 times of shock waves were possible to induce the damage of liver.

Role of the kidney in metabolic change of interleukin-2

The metabolic change of human recombinant interleukin-2 (IL-2) was investigated by the use of 125I-labeled IL-2 (125I-IL-2). After intravenous injection into mice, the distribution of 125I-IL-2 in various organs revealed that the major portion of injected 125I-IL-2 was rapidly accumulated in the kidney. Simultaneous injection of an excess amount of cold IL-2 greatly reduced the distribution of 125I-IL-2 to the kidney, suggesting that the accumulation of 125I-IL-2 by the kidney was a specific reactivity between 125I-IL-2 and the kidney. The gel filtration profile of 125I-IL-2 in the serum specimens remained the same as that of the originally injected sample, and differed completely from that in the urine specimens, suggesting that 125I-IL-2 was metabolized in the kidney. To confirm this notion, 125I-IL-2 was incubated in vitro with kidney homogenate, which degraded 125I-IL-2 in acidic pH. After subcellular fractionation, the cytosol fraction of the kidney was shown to hydrolyze 125I-IL-2 with an optimal pH of 4. The reactivity of the kidney cytosol fraction with 125I-IL-2 was inhibitable by pepstatin, an acid protease inhibitor, but not by TLCK or TPCK. Additional experiments using a heat-treated kidney cytosol fraction plus cathepsin D, and pepstatin inhibition on the degradation of 125I-IL-2 by cathepsin D, a major acid protease in the kidney, resulted in the identification of this enzyme to be responsible for the degradation of 125I-IL-2. Overall, these results demonstrated that the kidney is the organ to metabolize IL-2 and that cathepsin D, a renal acid protease, is involved in the degradation of IL-2.

Total replacement of the suprarenal inferior vena cava with an expanded polytetrafluoroethylene tube graft in 2 patients with tumor thrombi from renal cell carcinoma

Total replacement of the suprarenal inferior vena cava using an expanded polytetrafluoroethylene vascular graft was successful in 2 renal cell carcinoma patients with extended tumor thrombi densely adherent to the vena caval wall. Right radical nephrectomy in 1 patient and enucleation of the tumor in the solitary right kidney were performed concomitantly. Both patients are well without tumor recurrence and with good vena caval patency 14 and 6 months postoperatively. This procedure could be a safer mode of operation in cases of extended vena caval involvement by malignant tumors. Total reconstruction of the inferior vena cava enables more radical resection of the tumor.

[Therapeutic effect of ranimustine (MCNU) on essential thrombocythemia and polycythemia vera]

Seven patients with essential thrombocythemia and two patients with polycythemia vera were treated with ranimustine (MCNU). MCNU was given intravenously by drip infusion at a dose of 40-80 mg/m2 with intervals arranged in terns of the counts of both white blood cell and platelets. All cases with essential thrombocythemia obtained complete response, but the cases with polycythemia vera needed the combination of phlebotomy. The therapeutic effects were maintained for 2-5 months. No serious side effect was recognized except in two cases (22%) of mild nausea. Our study indicates that MCNU is useful for chemotherapy of chronic myeloproliferative disorders, especially, essential thrombocythemia.

[VAMA salvage regimen (VP-16, ARA-C, MTX and L-asparaginase) in relapsed or resistant non-Hodgkin's lymphoma]

A new salvage treatment protocol consisting of VP-16, cytosine arabinoside (Ara-C), methotrexate (MTX) and L-asparaginase, known as VAMA, was administered to twelve patients with relapsed or resistant non-Hodgkin's lymphoma. All twelve patients were in advanced stage with aggressive histologic type. Four of eight patients whose tumor cells had been immunologically determined, had T-cell phenotype. Three complete and five partial responses were obtained, for an overall response rate of 67%. It is of particular interest that all four patients with T-cell phenotype responded(CR; 3 cases, PR; 1 case), and a CR duration over 31 months has been achieved in a case of T-lymphoblastic lymphoma. Severe myelosuppression was the major toxic effect, but it was generally well-tolerated with supportive therapy. These results indicate that VAMA salvage regimen can play an important role in the treatment of relapsed or resistant non-Hodgkin's lymphoma.

[A case of metastatic liver cell carcinoma in the abdominal wall corresponding to the location of a buried arterial catheter]

The authors encountered a case of primary liver cell carcinoma which metastasized to the abdominal wall at a site corresponding to the location of an indwelling catheter for intra-arterial injections. The patient was a 54-year-old male with primary liver cell carcinoma in the posterior inferior segment. Because of a subsegmentectomy of the liver on September 25, 1986 and postoperative chemotherapy, a catheter for intra-arterial injections was inserted from the right gastroepiploic artery. After anticancer agents were administered postoperatively via this catheter, the same catheter was implanted subcutaneously before discharge. From the latter part of June 1987 after discharge, there was an increase in alpha FP and a subcutaneous tumor, which gradually increased in size, was found at a site in the right hypochondrium corresponding to the location of the arterial catheter. Angiography revealed a tumor nourished by the right 10th intercostal artery, and an operation was performed to remove this tumor. From a pathological examination, this case was diagnosed as metastatic liver cell carcinoma (metastasis to the abdominal wall). The tumor was not connected with the liver and matched the site in the abdominal wall where the arterial catheter was embedded. Therefore, implantation of a catheter cannot be ruled out as a mode of metastasis other than the blood stream.

Two-cusp plasty for the right ventricular outflow tract in complete repair of tetralogy of Fallot

A procedure termed two-cusp plasty, which prevents pulmonary regurgitation in complete repair of tetralogy of Fallot, is described.

[Injection of interleukin-2 (IL-2) into the tumor-bearer's spleen augments lymphokine-activated killer (LAK) activity in vitro and inhibits tumor metastasis]

The effect of interleukin-2 (IL-2), injected directly into the tumor-bearer's spleen, on inhibition of tumor metastasis was evaluated. C3H/HeN mice were inoculated intradermally with 2 X 10(6) X5563 syngeneic tumor cells on day 0, and the tumor was surgically resected on day 10. The operation failed to prevent tumor death of these mice within 3 weeks. Autopsy of these mice revealed that death was due to systemic metastasis of tumor cells to lymphoid organs including the liver although the tumors had been successfully removed without any visible local recurrence. In this model, we administered IL-2 by intrasplenic injection daily for 3 days after operation. Mice treated with an intrasplenic injection of IL-2 showed a significantly prolonged survival time. Histological findings after this treatment revealed lymphoid cell proliferation of the spleen, no metastatic foci were found in the liver. Lymphokine-activated killer (LAK) activity from IL-2 injected spleen was also augmented. Intravenous (i.v.) and subcutaneous (s.c.) administration of IL-2 were not effective. A major difficulty in achieving significant immunologic effect in vivo by IL-2 infusion is the relatively short half-life of IL-2. Therefore IL-2 administered directly into the responding lymphoid organ is theoretically reasonable. In fact, treatment with intrasplenic injection of IL-2 significantly augmented the antitumor activity. Splenic arterial infusion of IL-2 may be an appropriate route of administration for adjuvant immunotherapy in human cancer.

Duplicate origin of the vertebral artery: report of two cases

We report two cases showing duplicate origin of the vertebral artery; one with fenestaration of the distal portion of the left vertebral artery.

[Surgical resection of pulmonary metastases from colorectal carcinoma]

Twelve patients with pulmonary metastases of recurrent colorectal carcinoma underwent pulmonary resection at National Ohkura Hospital. The Cumulative five-year survival rate was 60 per cent. No correlation was found between the disease-free interval and survival following thoracotomy. There was a statistically significant difference in survival rates corresponding to Duke's classification of the primary lesion. Patients with solitary lesions had a better survival rate than patients with multiple lesions. We believe that the surgical treatment of pulmonary metastases in a select group of patients, i.e., those with solitary pulmonary lesions, will prolong survival and be curative in a number of patients.

Protective effects of urinary trypsin inhibitor in experimental shock

The effects of human urinary trypsin inhibitor (UTI) were studied in experimental shock models. Administration of 50,000 U/kg, i.v., of UTI protected against mortality from shock induced by burn, endotoxin or trauma. Aprotinin at a dose of 50,000 U/kg improved only endotoxin shock and showed a moderate but not significant effect on burn and traumatic shock. Administration of 50,000 U/kg, i.v., of UTI protected against the aggravation in systemic hemodynamics in canine hemorrhagic shock. Furthermore, in rat traumatic shock, 50,000 U/kg, i.v., administration of UTI significantly reversed the increased serum beta-glucuronidase and trypsin activities and the decreased hepatic ATP level, and it moderately suppressed the increased serum uric acid level. Aprotinin failed to affect all these biochemical changes induced by drum trauma. These results suggest that the protective effect of UTI against experimental shock is possibly exerted through lowering the elevated enzyme activities in the serum during shock.

[Pathophysiology and prognosis of acute pancreatitis--early and late prognostic signs]

The purpose of this study is to elucidate the pathophysiology of the acute pancreatitis and set up the criteria for assessing the severity of this disease. One hundred and fifty seven cases of acute pancreatitis were treated at the First Surgical Department of Tokyo University Hospital and its affiliated hospitals. They consisted of 24 severe cases, 76 moderate cases, and 57 mild cases according to our classification. In early stage ten parameters, namely, abnormalities of white cell count, platelet count, hematocrit, lactic acid dehydrogenase, blood urea nitrogen, serum calcium, base excess, PaCO2 and fasting blood glucose and age within 24 hours after admission and X-ray CT scan within 48 hours as early prognostic signs, enabled us to predict severe, moderate, or mild pancreatitis. More than 4 weeks later than the onset of acute pancreatitis, X-ray CT scan, white blood cell count, elevation of serum FDP level, endotoxemia and fall of plasma opsonic index served as good indicators to evaluate the severity of abdominal sepsis. In experimental pancreatitis, CH50 and opsonic index were remarkably decreased at 6 and 12 hours after induction of acute pancreatitis. As the above results, determination of early prognostic signs immediately after onset and late prognostic signs 3-4 weeks after onset is very important to evaluate and manage the acute pancreatitis patients.

[Two cases of paragangliomas of the cauda equina--case reports and review of the literature]

Paragangliomas are tumors arising in the paraganglia and rarely occurring in the cauda equina. We report two cases of paraganglioma arising in this region. The tumors exhibited a typical "Zellballen" pattern, and immunohistochemical studies were positive for neuron-specific enolase, but negative for S-100 protein and glial fibrillary acidic protein. Electron microscopic studies confirmed electron-dense neurosecretory types of granules in the tumor cells. Only 23 cases of paragangliomas in this region have been previously reported. A brief review of the literature is included.

[Effects of human urinary trypsin inhibitor against operative stress]

Effects of human urinary trypsin inhibitor (MTI) against operative stress were investigated. Laparotomy in a mouse caused suppression of immunological functions such as phagocytic activity and antibody formation, followed by loss of resistivity to bacterial infection and acceleration of growth of concealed tumor. The operation also caused damages to the body such as enhancement of protein catabolism and suppression of renal function, followed by increase of blood urea nitrogen, increase of protease activity in skeletal muscle and suppression of PSP clearance. Since MTI wholly ameliorated these undesirable conditions of the body caused by operative stress, it was suggested that MTI has an effect on maintaining the homeostasis of the living body as well as the ability to inhibit trypsin.

The effects of pepsin on the natural progression of autoimmunity in glomerulonephritis in the NZB/W F1 mouse

The effects of pepsin on autoimmune glomerulonephritis of New Zealand Black and White F1 hybrid (NZB/W F1) mice were investigated. Intravenous pepsin significantly improved survival rate and suppressed progressive increase in urinary protein and histopathological changes in kidney. Increased serum levels of immune complexes, anti-DNA antibody and natural thymocytotoxic autoantibody were decreased and abnormalities in lymphocyte subsets were ameliorated by pepsin. Pepsin suppressed autoantibody production and enhanced antibody production against xenogeneic substance in these mice. The fact that pepsin ameliorates abnormalities in immune function may contribute to the preventive effects of pepsin against pathogenesis and progression of immune complex nephritis.

Pepsin like enzyme in macrophages and its role in the immune system

Phagocytosis by DBA/2 or autoimmune NZB mouse macrophages of sheep erythrocytes, which are heterologous to these macrophages, was enhanced by mouse pepsin, whereas phagocytosis of homologous erythrocytes was suppressed by pepsin. Antibody production by DBA/2 or NZB mouse lymphocytes against heterologous erythrocytes was also enhanced by pepsin, but autoantibody production by NZB mouse lymphocytes was suppressed by pepsin. An acid protease present in macrophages was found to have biochemical properties quite close to those of pepsin, with regard to molecular weight, isoelectric point, and 50% inhibition dose of pepstatin. This acid protease was immunochemically identical with pepsin, reacting with anti-pepsin antibody. Taken together, these results indicate that pepsin modulates macrophage functions and that the pepsin like enzyme in macrophages may play important roles in the regulation of phagocytosis by macrophages and in antibody production.

Effects of protizinic acid on leukokinin generation and its physiological action

The effect of protizinic acid (PRT), a non-steroidal antiinflammatory drug, on the in vivo leukokinin (LK) generation system using feline acute ischemia model, in vitro LK generation system and the LK-induced contraction of the isolated smooth muscle was investigated. When 3 mg/kg PRT was injected twice intravenously to cats with acute cardiac ischemia, increased blood acid protease activity was inhibited and significant inhibitory action on the decrease of leukokininogen, the precursor of LK, was observed. Simultaneously, ST-segment elevation on the electrocardiogram tended to be suppressed and the lowered mean aortic blood pressure was significantly restored. On the LK generation induced by rabbit kininogen and acid protease derived from mouse L-1210 leukemic cells or rabbit polymorphonuclear leukocytes, PRT showed a dose-dependent inhibition while indomethacin (IM) and ibuprofen (IB) at a concentration of 3 X 10(-4) M showed no effect. However, potencies of the inhibitory actions of PRT, IM and IB on the LK generation induced by bovine spleen cathepsin D were almost the same at a concentration of 3 X 10(-4) M. Furthermore, PRT as well as IM showed antagonistic action on the isolated rat uterine contraction induced by LK. These results suggest that PRT not only inhibits the in vitro and in vivo generation of LK but also antagonizes to it on the receptor site of LK.

[Intramedullary holocord tumor. Report of an autopsy case and review of literature]

This report describes a case of cystic astrocytoma that extended from C4 to the conus, and reviews intramedullary holocord tumors. A two-year-old body was admitted because of gait disturbance. He had suffered from rigidity of his left upper and lower limbs and thoracic scoliosis for six months prior to admission. On admission, neurologic examination revealed spastic paraparesis with muscle atrophy of the left lower extremity, sphincter disturbances and neck rigidity. All deep tendon reflexes were bilaterally hyperactive. Spine roentgenography demonstrated widening of the interpedicular distance from the midthoracic to the upper lumbar segments. A lumbar myelography disclosed a block at the L2 level, and a suboccipital myelography revealed a block with tapering of contrast medium at the level of the C2 vertebra. A laminectomy was performed from C1 to L3, and a myelotomy was performed from C4 to L2. Grossly total removal of solid tumor which extended from Th3 to Th8 was carried out. There were large intramedullary cysts extending from C4 to Th3, and from Th9 to L2. Eight hours after surgery, high fever, tachycardia and anuria developed, and he died next day. Cross section of the spinal cord revealed the tumor cells infiltrated diffusely in the midthoracic region, and histologically the tumor was diagnosed to be astrocytoma. The cystic portion was separate from the central canal, and the lining of the cyst was a band of fibroglial tissue without infiltration of tumor cells. A tumor of this kind extending throughout the almost whole spinal cord is extremely rate. For such a holocord tumor complete removal is the ideal treatment, but the possibilities for removal must be evaluated in terms of the tumor's relationship to the spinal cord, the histological nature and the general condition of the patient.

[The effects of human and mouse pepsins on Masugi nephritis]

The effects of intravenous administration of human or mouse pepsin were investigated on Masugi nephritis in rats and mice, which is an experimental model of glomerulonephritis in humans. Injection of anti-kidney serum to rats significantly increased the urinary protein excretion, serum levels of fibrinogen, cholesterol and immune complex, significantly decreased serum immunoglobulin G and complement levels, and caused histopathological changes such as detachment of endothelial cells from basement membrane, thickening of basement membrane, fusion of foot process and increase in hyaline cast in renal tubuli. Deposit of anti-rat IgG on glomerular capillary wall was also observed. All of these changes were ameliorated or showed a tendency to be ameliorated by intravenous administration of human pepsin, and the mechanism responsible for these effects was suggested to be selective decomposition of immune complex. Marked increase in urinary protein excretion was also observed in mice that intravenously received anti-kidney serum. This increase was suppressed by intravenous administration of human or mouse serum, the latter showing a stronger effect.

Pepsin-immunoregulation hypothesis

Pepsin exists in macrophages. Phagocytosis of foreign materials increases pepsin activity in macrophages and also causes extracellular release of pepsin from macrophages. Pepsin enhances antibody production by spleen cells against heterologous materials and suppresses that against homologous materials. Pepsin selectively decomposes immune complexes at neutral pH, and intravenous pepsin ameliorates symptoms in autoimmune disease models, such as immune complex glomerulonephritis in MRL/l mice and SLE-like syndromes of NZB/W F1 mice. These results prompted us to propose a "pepsin-immunoregulation hypothesis", according to which pepsin acts as a regulating factor in the immune system.

Effects of urinary trypsin inhibitor on pancreatic enzymes and experimental acute pancreatitis

Therapeutic effect and the mechanism of the action of human urinary trypsin inhibitor (MTI) on experimental acute pancreatitis were studied. MTI significantly increased survival rate of animals with experimental acute pancreatitis induced by the infusion of trypsin or phospholipase A2 into pancreas or by a closed duodenal loop. The efficacy of MTI on these types of pancreatitis were higher than those of aprotinin. Pancreatic enzymes were released from pancreatic slice by trypsin or phospholipase A2, and this release was inhibited by MTI. Further, these pancreatic enzymes caused a secondary release of enzymes from other pancreatic slice, suggesting that these enzymes injured pancreatic tissue and that a chain reaction of pancreatic enzyme activation may play an important role in the pathogenesis of acute pancreatitis. MTI suppressed the secondary enzyme-induced pancreatic injury more strongly than aprotinin. These results suggest that MTI may suppress pathogenesis and development of pancreatitis by inhibiting the chain reaction of pancreatic enzyme activation.

Mechanism of action of AC-1370 on phagocyte functions

The mechanism of action of a new semisynthetic cephalosporin AC-1370 on phagocyte functions was investigated. AC-1370 enhanced phagocytic functions of macrophages and neutrophils. AC-1370 bound to 27.4% of mouse peritoneal resident cells. Most of the AC-1370-binding cells were macrophages, and few neutrophils bound AC-1370. Culture supernatant of mouse macrophages cultured with AC-1370 significantly augmented phagocytic functions of mouse neutrophils. This activity of the culture supernatant of AC-1370-stimulated macrophages was abolished by digestion with trypsin but not by heat treatment at 56 degrees C for 30 min. The mechanism of the activation of phagocyte functions by AC-1370 is proposed as follows. First, AC-1370 binds to macrophages and causes their activation. Second, trypsin-sensitive and heat-stable soluble factor(s) is released from these macrophages. And finally, neutrophil functions are activated by the factor(s).

[Skin sensitization of costus root oil and peripheral lymphocyte count in gastric and colon cancers]

Costus root oil is a new primary sensitizer to examine the delayed, cell-mediated immune system. The peripheral blood lymphocyte count has been measured in 68 cases of carcinoma of the stomach and colon. The count has been correlated with the stage of tumor spread and the patient's delayed hypersensitivity response to costus root oil. A statistically significant correlation was found between the peripheral blood lymphocyte count and the response to costus root oil. Patients with low peripheral blood lymphocyte counts tended to have more advanced tumors and a poor response to costus root oil.