Ex vivo expansion of umbilical cord blood hematopoietic progenitor cells by combinations of cytokines

Ex vivo expansion of hematopoietic progenitor cells in the umbilical cord blood mononuclear cells (CB-MNC) was investigated in liquid culture system with various combinations of cytokines (stem cell factor [SCF], interleukin [IL]-3, IL-6, granulocyte-colony stimulating factor [G-CSF], erythropoietin [EPO], and interferon [INF]-gamma). Non-lineage-committed hematopoietic progenitor cells and lineage committed hematopoietic progenitor cells were represented as CD34+CD38- and CD34+CD38+ subpopulations, respectively. Although absolute CD34+CD38- cell numbers decreased even in the presence of multicytokines, the combinations of SCF plus IL-6 and SCF plus IL-3 plus IL-6 plus IFN-gamma were significantly effective in maintaining CD34+CD38- cells than the other combinations (P < 0.05). After 4 weeks of culture. CD34+CD38- cells disappeared in all combinations of cytokines. Absolute CD34+CD38+ cell numbers increased in the presence of cytokines. Maximal expansion of CD34+CD38+ cells were observed in the combinations of SCF plus IL-3 plus IL-6 plus EPO (19.8 +/- 3.3-fold) and SCF plus IL-3 plus IL-6 plus G-CSF (18.3 +/- 2.6). The combination of SCF plus IL-3 plus IL-6 was also effective to expand CD34+CD38- cells (15.8 +/- 3.9). However, the expansion was transient and they decreased to zero within 3 weeks. In the combinations of SCF plus IL-6 and SCF plus IL-3 plus IL-6 plus INF-gamma, maximal expansion was inferior to the others but CD34+CD38+ cells were maintained more than 4 weeks. These results suggested that the indication of CBT can be expanded into older children by ex vivo augmentation of CB hematopoietic progenitor cells using multi-cytokines.

Intracellular multiplication of Legionella pneumophila in HL-60 cells functionally differentiated in response to 22-oxacalcitriol

The agent 1,25-dihydroxyvitamin D3 (D3) induces the differentiation of HL-60 human leukemia cells into functional monocyte-like cells that can support the intracellular multiplication of Legionella pneumophila. 22-Oxacalcitriol (OCT), a synthetic analogue of D3, exhibits greater differentiation-inducing activity than D3 in WEHI-3 mouse leukemia cells and has been suggested to be clinically more useful because of its lower hypercalcemic activity. The abilities of OCT and D3 to induce the functional differentiation of human leukemia HL-60 cells have now been investigated. OCT induced the differentiation of HL-60 cells into monocyte-like cells to a similar extent as D3. Thus, both OCT and D3 increased (1) the surface expression of CD11b, CD11c, CD14, and CD35; (2) nonspecific esterase staining; and (3) phagocytic activity toward fluorescent beads. HL-60 cells differentiated in response to OCT also supported the intracellular multiplication of L. pneumophila. Activation of both OCT- and D3-treated HL-60 cells with human recombinant interferon-gamma (IFN-gamma) for 24 h before infection markedly inhibited L. pneumophila multiplication. IFN-gamma activation enhanced superoxide anion generation by D3-treated HL-60 cells but not by OCT-treated HL-60 cells, suggesting that the inhibition of L. pneumophila multiplication in IFN-gamma-activated cells is independent of superoxide generation. Finally, D3, but not OCT, markedly stimulated the formation of osteoclast-like multinucleated cells from mouse bone marrow cells, consistent with the lower hypercalcemic activity of OCT.

Stage-assessment of the progress of continuous vertigo of peripheral origin by means of spontaneous and head-shaking nystagmus findings

The stages of continuous vertigo of peripheral origin were classified into nine categories according to the findings of spontaneous nystagmus (SPN) and head-shaking nystagmus (HSN). The patients analysed were 18 with vestibular neuronitis, 6 with sudden deafness and 6 with unilateral inner ear disorders. 1) Irritative SPN (Stage I) was rarely encountered. 2) SPN of the paralytic type (Stage II) was usually observed in the period less than one month after the onset of diseases. 3) HSN directed toward the intact side with or without a reversal phase (Stages III-2 and III-1, respectively) were the common types of central compensation. 4) The progress of recovery to complete cure (Stage V) was usually rapid once it had actually begun. 5) During the process of recovery, HSN could disappear transitorily (Stage III-3), or be directed toward the affected side without a reversal phase (Stage III-5). Spontaneous recovery nystagmus (Stage IV) could also occur. 6) About 40% of patients recovered to Stage V within about 4 months after the onset of vertigo, but about 30% of patients remained in Stage III-1 or III-2 even after 4 months.

A quantitative analysis of head-shaking nystagmus of peripheral vestibular origin

A quantitative analysis of horizontal head-shaking nystagmus (HSN) was made on 48 patients with unilateral peripheral vestibular lesions in conjunction with stimulus intensity. Each patient underwent three head-shaking tests with 10, 30 and 50 horizontal head-excursions at a frequency of approximately 2 Hz, and HSN was recorded on ENG with eyes open in total darkness. i) HSN appeared in a biphasic or monophasic pattern. ii) The maximal slow-phase eye velocity (MSV) of the 1st phase (PI) of biphasic HSN increased significantly in proportion to stimulus intensity, and was significantly greater than that of monophasic HSN. iii) The duration of HSN was greater in the 2nd phase (PII) of biphasic HSN than in PI and increased markedly in proportion to stimulus intensity. iv) As the stimulus intensity rose to a high level, the interval between PI and PII (2nd phase latency) shortened, and the PII tended to appear more quickly after head-shaking. It was especially noteworthy that in response to an increase in stimulus intensity, both the MSV in PI and the duration of PII of biphasic HSN increased, but the duration of PI was reversely suppressed by the PII.

Effects of nifedipine on mechanical properties of the normal and atherosclerotic descending aorta assessed by transesophageal echocardiography

We assessed the effects of calcium ion (Ca++) entry blockade (nifedipine) on the static elastic properties of the thoracic descending aorta in 60 subjects classified into 4 groups according to age and complications. The stiffness index (beta), which expresses the mechanical properties of the arterial wall, was calculated from the dimensional changes of the thoracic aorta by transesophageal echocardiography and blood pressure was determined by conventional cuff method. After administration of nifedipine, beta was significantly decreased in all groups. There was a significant correlation between beta at rest and the value of a decrease in beta after nifedipine in the relatively younger and the older groups with complications, but no significant correlation was observed in the older group without complications. Nifedipine directly reduces the stiffness of the descending aorta. The effect is stronger in relatively younger subjects, especially in subjects with risk factors of atherosclerosis and stiff descending aorta at rest. These results suggest that there may be a reversible sclerotic property of the descending aorta, probably caused by high smooth muscle tone before an irreversible atherosclerosis occurs in patients with risk factors promoting atherosclerosis.

[A simple method for differentiation of hydrogen sulfide-producing bacteria by the pH-dependent EDTA-sensitivity test]

The pH-dependent EDTA-sensitivity test was performed to differentiate several strains of bacteria forming black colonies by the production of hydrogen sulfide on TCBS (thiosulfate-citrate-bile salt-sucrose agar) medium (tentatively designated as hydrogen-sulfide production bacteria). Two halotorelant strains of 16 hydrogen sulfide-producing strains showed the same bacteriological properties and isoprenoid quinone type as did a reference strain of Proteus mirabilis and were classified into the EDTA-insensitive group as were P. mirabilis and P. vulgaris. On the other hand, the other 14 halophilic strains, showing similar but not identical bacteriological properties or the isoprenoid quinone type to those of Shewanella putrefaciens IFO 3908, were classified into the "EDTA-sensitive (at pH 5)" group as were some species of the genus Vibrio. By the same sensitivity test, S. putrefaciens IFO 3908 was classified into the "EDTA-sensitive (at any pH)" group. These results indicate that the pH-dependent EDTA-sensitivity test is useful for differentiation of bacterial isolates producing hydrogen sulfide and having similar bacteriological properties.

Clinical importance of extraordinary integration patterns of human T-cell lymphotropic virus type I proviral DNA in adult T-cell leukemia/lymphoma

The proviral DNA of human T-cell lymphotrophic virus type I (HTLV-I) is known to be integrated monoclonally in the malignant cells of adult T-cell leukemia/lymphoma (ATL), which is a peripheral T-cell malignancy caused by this virus. We studied the relationship between the integration patterns of HTLV-I and clinical characteristics in 89 patients with ATL. The proviral DNA of HTLV-I was examined by the standard Southern blot analysis using the endonucleases EcoRI and Pst I. One clear band of greater than 9 kb was detected in most of the patients (83 case) when cellular DNA was digested with EcoRI. On the other hand, extraordinary integration patterns of HTLV-I proviral DNA were detected in 6 patients; 3 of them showed two bands, while the other 3 showed one band smaller than 9 kb. When cellular DNA was digested with PstI, the band patterns of these patients were quite different from those of typical patients. The patients with the extraordinary integration patterns had clinical characteristics dissimilar to those of the other 83 patients with the ordinary integration pattern. The patients with two bands by EcoRI digestion always had severe hypoxemia with extremely high levels of serum lactate dehydrogenase at first presentation and showed peculiar organ infiltrations, such as retina and muscle, which were less frequent in the other ordinary 83 patients. They all died within 8 months after the onset. In contrast, the patients with one smaller band by EcoRI digestion always had small and mature T lymphocytes with bilobulated nuclei without lymphadenopathy and showed a favorable clinical course, which was uncommon in the ordinary cases. They were alive 20 to 38 months after diagnosis. Rearranged bands of the T-cell receptor gene were detected in all patients with unusual integration. These findings indicate that the integration patterns of HTLV-I proviral DNA have a clinical implication and may be one of the explanations for heterogeneity in the behavior of this disease.

A model study of time- and voltage-dependent effects of class I antiarrhythmic drugs in guinea-pig papillary muscles as related to external potassium concentration

1. A piecewise exponential three-state model previously introduced by the authors in 5.4 mmol/l was intended to apply to states with different [K+]o and with a different drug. Using the conventional microelectrode technique the effects of 20 mumol/l mexiletine (MEX), 5 mumol/l aprindine (APR), 20 mumol/l quinidine (QUI), 5 mumol/l flecainide (FLE), 5 mumol/l E-0747 (dl-6-chloro-2,2'-dimethyl-1'-[3-(4-hydroxypiperizino)propyl]spiro [chroman-4,4'-imidazolidine]-2',5'-dione hydrochloride and 100 mumol/l QX-222, a quaternary derivative of lidocaine, on action potentials (APs) in guinea-pig papillary muscles were studied. Specific objects of the study were (1) steady state Vmax values at various frequencies (all drugs), (2) the recovery process of Vmax in premature responses (MEX) and (3) Vmax changes during a train of stimulation at 1 Hz after a rest period (all other drugs) in 2.7 and 10 mmol/l [K+]o. Further, those of APR alone and APR plus 1 mmol/l nicorandil (NIC), which shortened action potential durations (APDs) specifically, were investigated on the above items (1) and (3) in 5.4 mmol/l [K+]o. 2. All the drugs reduced the Vmax of APs frequency-dependently and, except QX-222, more markedly in 10 mmol/l [K+]o than in 2.7 mmol/l [K+]o at 1 Hz. 3. The rate constants estimated from the model fitting characterized MEX and APR and the other drugs as predominantly inactivated and activated channel blockers, respectively. The calculated rate of onset of block, lambda T, does not differ much between the three [K+]o levels. lambda T shows that APR belongs to class Ia rather than class Ib.(ABSTRACT TRUNCATED AT 250 WORDS)

Influence of left ventricular regional nonuniformity on afterload-dependent relaxation in intact dogs

The time course of systolic loading conditions is considered an important factor in affecting left ventricular (LV) relaxation. However, the exact underlying mechanisms remain controversial. The goal of this study was to evaluate the role of the change in loading sequence on LV regional wall motion and LV relaxation. Early and late systolic loading were produced by constricting the ascending aorta and the descending aorta, respectively, in seven anesthetized dogs. In two pairs of cardiac beats with a comparable peak LV pressure during the mild and moderate constrictions of the ascending or descending aorta, we measured LV time constant (T) of LV pressure decay and determined regional nonuniformity in basal and apical segmental motion during the isovolumic relaxation period (by Lew's method). Constriction of the descending aorta led to a significant delay of the timing of peak LV pressure, associated with an increase in T, end-systolic pressure, and the regional nonuniformity between the two segments. T was correlated well with the amount of the nonuniformity, suggesting that LV regional nonuniformity between basal and apical regions might be involved in the complex mechanism of afterload-dependent relaxation.

[Depression in the field of internal medicine]

Masked depression is a common case of depression observed in the field of internal medicine. Masked depression redeems the organic disease alone, and so is often detected in the case of unidentified complaints. Symptomatic depression associated with the underlying disease is another type of depression that is commonly observed. In addition, there is the so-called "premonitory depression", which must be regarded as clinically important. This report describes our experience in the treatment of premonitory depression, with discussion on the consequence of manifestation of depression as the primary symptom of malignant tumor.

Effect of left ventricular contractile performance on passive left atrial filling--clinical study using radionuclide angiography

Many invasive and noninvasive methods have been used to study the cardiac atria; however, few allow quantitative measurement of atrial function. To determine the interaction between left ventricular (LV) contraction and left atrial (LA) filling, gated radionuclide angiography was conducted in 30 normal subjects (24 men and 6 women, mean age 58 +/- 10 years, range 26-68). LV and LA time-activity curves and their first-derivative curves were obtained simultaneously by using the method of Bough et al. The LV ejection fraction (64 +/- 18%) and LV peak ejection rate (LVPER; 3.42 +/- 0.27 EDV/s) were computed from these curves. As indices of LA filling, LA fractional emptying (38 +/- 12%) and LA peak filling rate (LAPFR; 2.86 +/- 0.17 LAVmax/s)--the latter being defined as the peak rate of LA filling during the LA filling phase--were also computed from these curves. In all subjects, the timing of the LVPER coincided with the occurrence of LAPFR, and there was a significant positive correlation between the LVPER and LAPFR (r = 0.81, p < 0.001), indicating that the LAPFR was strongly affected by the degree of LVPER. Thus, these results indicate that LV contractile performance plays an important role in determining LA passive filling during ventricular systole.

Liver function tests of recipients with hepatitis C virus infection after bone marrow transplantation

We used the polymerase chain reaction (PCR) to determine the presence of hepatitis C virus (HCV)-RNA in serum samples obtained from 19 patients with leukaemia or severe aplastic anaemia and investigated the correlation between HCV status and the results of liver function tests after bone marrow transplantation. PCR analysis of serum samples obtained before transplant showed that 10 of 18 patients were HCV-RNA-positive; 5 of these patients had developed acute post-transfusion hepatitis 1-11 months before transplant. An additional patient was HCV-RNA-positive on post-transplant day 62. Eight HCV-RNA-positive patients had pre-transplant GPT levels above the upper limit of normal. In these patients the GPT decreased significantly from a median of 104 IU/l (54-822 IU/l) pre-transplant to 23 IU/l (15-56 IU/l) on post-transplant days 8-12. In 9 of 11 HCV-RNA-positive patients, the GPT increased transiently from days 40 to 50 and again increased after day 100. Two of these patients died from hepatic failure; the GPT levels normalised in 3 patients after day 300 but continued to fluctuate in 4 patients. In the remaining 2 HCV-RNA-positive patients, the GPT remained close to the normal range throughout the follow-up period. Three HCV-RNA-positive patients became HCV-RNA-negative after 1-3 years. In these patients, the GPT remained normal for > 3 years after day 300.(ABSTRACT TRUNCATED AT 250 WORDS)

Serum levels of soluble IL-2R, IL-4, and soluble Fc epsilon RII in adult bronchial asthma

Examination was made of the serum levels of interleukin 4 (IL-4), soluble Fc epsilon RII (sFc epsilon RII), and soluble interleukin 2 receptor (sIL-2R) in 77 adult patients with bronchial asthma. All the patients had mild to moderate asthma and their symptoms were well controlled. The results were compared with values for 75 control subjects to clarify the involvement of these factors in the pathogenesis of bronchial asthma. Serum sIL-2R was elevated in asthmatics compared with control subjects (459.0 +/- 30.4 U/ml vs 251.5 +/- 10.0 U/ml; p < 0.001). The IL-4 and sFc epsilon RII levels were also elevated beyond those in the controls (IL-4: 1.89 +/- 0.13 pg/ml vs 1.08 +/- 0.15 pg/ml; p < 0.001) (sFc epsilon RII: 313.2 +/- 18.8 U/ml vs 228.8 +/- 6.7 U/ml, p < 0.001). A weak but significant correlation was observed between sIL-2R and sFc epsilon RII (r = 0.46, p < 0.001). Correlation among other parameters was not found. The patients were divided into atopic and nonatopic groups, based on the presence or absence of positive reaction to skin prick tests using extracts of common aeroallergens and positive specific IgE against house dust mite (Dermatophagoides pteronyssinus [Dp]). Mean IL-4 in the atopic group, with positive skin reaction and > 0.7 kU/L specific IgE against Dp was significantly elevated compared with the nonatopic group (2.35 +/- 0.26 pg/ml vs 1.56 +/- 0.12 pg/ml; p < 0.005). Such differences could not be detected in sIL-2R, sFc epsilon RII levels among the two groups. No significant correlation could be found among IL-4, sFc epsilon RII, and total IgE level. The activation of T cells and B cells would thus appear essential to the pathogenesis of bronchial asthma and the hypothesis that atopic status is associated with the preferential activation of TH2 cells which selectively produce IL-4 could be supported. The regulatory mechanism of IgE synthesis would not appear to be the only responsible factor.

[VEPA and ML-Y1 regimen for elderly non-Hodgkin's lymphoma]

A total of 32 previously untreated patients aged 65 years or older with non-Hodgkin's lymphoma (NHL) were treated with VEPA (vincristine, cyclophosphamide, prednisolone and doxorubicin) or ML-Y1 (doxorubicin, cyclophosphamide, vincristine, methotrexate, bleomycin, procarbazizin and prednisolone). The median age of the patients was 70 years (range 65-77), 19 males and 13 females. The outcome of 16 patients with VEPA and 16 patients with ML-Y1 was retrospectively evaluated. There were no significant differences in response or survival between VEPA and ML-Y1, complete remission rates were 37.5% vs. 31.3% and duration of 50% survival were 20 months and 13 months, respectively. Major side effects of both regimens were myelosuppression, hair loss, nausea, vomiting and peripheral neuropathy. There was no increased toxicity in ML-Y1 but this regimen seemed like VEPA, to be insufficient for NHL in elderly patients. A new intensive regimen should be designed to treat NHL in the elderly patients.

[A case of myelodysplastic syndrome with pericarditis due to atypical Mycobacterium]

A 28-year-old woman with high fever and cough was admitted because of an abnormal shadow on the chest X-ray film. Mycobacterium kansasii was detected by sputum culture. The complete blood cell count disclosed pancytopenia and the myelogram showed slight hypoplasia and abnormality of the cell morphology. We diagnosed her disease as atypical mycobacteriosis and myelodysplastic syndrome. We began medical therapy with antituberculous drugs against Mycobacterium kansassi, and the sputum culture became negative. She was discharged after 4 months, but cardiothoracic ratio (CTR) increased gradually and pericardial effusion was detected by echocardiogram during follow-up. She was admitted again. We did not perform exploratory puncture, because the pericardial effusion did not increase for 6 months after admission and she had no complaints. We continued the antituberculous drugs, and CTR and the pericardial effusion decreased during follow-up. We considered the diagnosis in this case to be pericarditis due to Mycobacterium kansasii.

The effect of orally-administered retinoid on lectin binding in guinea pig keratinocytes

Retinoids influence proliferation and differentiation of epithelial cells. The present paper was designed to examine the change of lectin binding in isolated keratinocytes from retinoid-treated guinea pigs. Aromatic retinoid, etretinate, in peanut oil (5 mg/kg/day) was given orally for a period of 14 days. Skin samples were obtained from animals on days 1, 3, 7, and 14 after beginning the administration. Free keratinocytes were obtained by treatment with EDTA and trypsin. They were separated into 3 fractions by centrifugation on a continuous colloidal silica (Percoll) density gradient. The cells in each fraction were stained by biotinyl lectins and avidin-FITC, and the fluorescence intensity was measured by cytofluorometry. The lectins used were Concanavalin A (Con A), soybean agglutinin (SBA), peanut agglutinin (PNA), Dolichos biflorus agglutinin (DBA), and Ricinus communis agglutinin (RCA). The PNA-binding was diminished in both the intermediate and lower density fractions at 7 and 14 days. The binding of SBA was reduced in all fractions from 1 to 7 days. With Con A, RCA and DBA, no changes in intensity were found.

Essential thrombocythemia terminating in acute leukemia with minimal myeloid differentiation--a brief review of recent literature

Essential thrombocythemia (ET), one of the chronic myeloproliferative disorders, is a clonal disorder of multipotent stem cells. Although most patients with ET have a prolonged benign course, a minority of patients may develop a blastic crisis similar to chronic myelogenous leukemia (CML). A case of ET terminating in blastic crisis 8 years after the initial diagnosis is presented. The blast cells were cytochemically and immunophenotypically consistent with the acute myelogenous leukemia with minimal myeloid differentiation subtype of the FAB classification. From the review of the literature on blastic transformation of ET, acute leukemia with an M4 or M7 phenotype occurred more frequently. In addition, three valuable factors to predict the leukemic transformation of ET appear to be karyotypic abnormalities, such as involvement of chromosome 21, previous therapies with a mutagenic potential, and the capability of bone marrow cells to form in vitro spontaneous colonies as in CML.

Adenylate cyclase activation promotes the recruitment of coronary vasodilator reserve and improves subendocardial contractility during coronary hypoperfusion

This study was designed to examine the effects of an adenylate cyclase activator, NKH477, on epicardial and endocardial contraction and coronary blood flow (CoF) in the presence or absence of ischemia and to compare it to those of adenosine. We measured coronary pressures (CoP), coronary blood flow, epicardial and endocardial wall thickening (i.e., %EPWT and %ENWT, respectively, by sonomicrometry) in 18 anesthetized dogs. The left circumflex coronary artery was perfused with arterial blood using a pressure controlled servo pump. Propranolol (0.5 mg/kg) and atropine (0.25 mg) were used to minimize the neurogenic effects. CoP decreased from 100 mm Hg to 40 mm Hg with and without drugs. At CoP of 100 mm Hg, intracoronary infusion of NKH477 (10(-8) M/kg/min) produced a two-fold increase in CoF, but there were no changes in either the %EPWT or the %ENWT. During coronary hypofusion at coronary pressures equal to 40 mm Hg, NKH477 increased CoF from 16 +/- 2 to 28 +/- 4 mL/min (p < 0.05) and improved %ENWT significantly from 6 +/- 7 to 23 +/- 7% (p < 0.05). However %EPWT was not improved by NKH477. On the other hand, the intracoronary infusion of adenosine (10 micrograms/kg/min) increased CoF from 16 +/- 5 to 21 +/- 6 mL/min (p < 0.05) at CoP of 40 mm Hg. However, this dose of adenosine failed to improve %ENWT (16 +/- 10% vs. 14 +/- 10%, n.s.). Thus, the improvement of subendocardial function by NKH477 might be related to the improvement of subendocardial perfusion which could be induced by the potentiation of endogenously released adenosine as well as the direct vasodilator effect. This contrasts with the effects of exogenously administered adenosine, which failed to improve subendocardial contractility.