[Study on clinical and laboratory features of preleukemia patients]

OBJECTIVE

To explore prospective diagnostic criteria for preleukemia.

METHODS

A case control study of the discrepancies of clinical and laboratory features between patients with preleukemia and those with chronic aplastic anemia (CAA) or atypical paroxysmal nocturnal hemoglubinuria (a-PNH).

RESULTS

There were eight variables of significance: (1) lymphocytoid micromegakaryocytes in marrow; (2) immature granulocytes in peripheral blood; (3) >or= 2% myeloblasts in marrow; (4) positive periodic acid schiff (PAS) staining of nucleated erythrocytes; (5) myeloid differentiation index >or= 1.8; (6) clonal karyotypic abnormalities; (7) negative sister chromatid differentiation; (8) > 4.0 cluster/colony ratio of granulocyte-macrophage colony-forming units (CFU-GM). The following criteria was assigned: A: To meet (1) and at least two of the other seven variables; B: To meet at least four of the eight variables. All of the patients with preleukemia met A or B and none of the patients with CAA or a-PNH did.

CONCLUSION

Preleukemia is different from CAA or a-PNH. It has its own clinical and laboratory features, which may be useful for prospective diagnosis.

[Changes of surfactant A and B in alveolar type II cells in hamster with elastase-induced emphysema]

OBJECTIVE

To observe the changes of surfactant A and B (SP-A and SP-B) in alveolar type II cells of lungs in hamsters with elastase-induced emphysema.

METHODS

After intratracheal instilling of elastase, hamsters were killed at the 30th, 60th and 90th day of the experiment respectively. Slides of lung tissue were examined under light microscope and measured by calculating the mean linear intercepts. Then the slides were stained under immunohistochemistry procedures and measured by using a morphometric analysis system. Meanwhile, slides were also checked by electron microscopy.

RESULTS

In comparison with the normal group, MLI of the elastase group was significantly increased (P < 0.01). Immunohistochemistry showed that the percentage of both SP-A and SP-B positive cells was significantly decreased 30 days after the intratracheal instilling of elastase (from 48.0% +/- 3.0% to 9.5% +/- 4.0% and from 28.0% +/- 4.0% to 13.3% +/- 4.1%, respectively; P < 0.01), however, a time-dependent recovery 90 days after instilling was seen. Electron microscopy showed a significantly decrease of the number of lamellae.

CONCLUSION

The decrease of SP-A and SP-B in alveolar type II cells seems to play an important role in the development of emphysema.

Gene therapy of hypertensive vascular injury

Hypertension and vascular injury usually require prolonged treatment, and compliance is a key to efficacy for pharmacologically-based antihypertensive therapy. Gene therapy has the potential to be long lasting, with few side effects. Recent studies have provided promising results, in which hypertension can be treated by either augmentation of vasodilation or inhibition of vasoconstriction through gene transfer in experimental models. Gene transfer is also becoming useful for the study of mechanisms of physiologic and pathophysiologic conditions, including hypertension. In this mini-review, we summarize some recent studies in this area of research, and suggest some areas where progress is needed to advance the research toward gene therapy.

Obtaining maximal optic nerve length during enucleation procedures

OBJECTIVE

To determine optimal scissor blade design and surgical approach to facilitate obtaining a long optic nerve segment during enucleation procedures.

METHODS

Two hundred mock enucleations were performed with the use of a human child skull model and a silicone sphere to simulate an eye. Temporal and nasal approaches with scissor blades with noncurved, mildly curved, or strongly curved blades were tested.

RESULTS

Longer optic nerve segments were obtained with mildly curved scissor blades from both temporal and nasal surgical approaches. Strongly curved scissor blades uniformly produced smaller specimens.

CONCLUSIONS

Mildly curved scissors should be used for enucleation when a long optic nerve specimen is desired. Strongly curved scissors should be avoided.

Lentiviral gene transfer to the nonhuman primate brain

Lentiviral vectors infect quiescent cells and allow for the delivery of genes to discrete brain regions. The present study assessed whether stable lentiviral gene transduction can be achieved in the monkey nigrostriatal system. Three young adult Rhesus monkeys received injections of a lentiviral vector encoding for the marker gene beta galatosidase (beta Gal). On one side of the brain, each monkey received multiple lentivirus injections into the caudate and putamen. On the opposite side, each animal received a single injection aimed at the substantia nigra. The first two monkeys were sacrificed 1 month postinjection, while the third monkey was sacrificed 3 months postinjection. Robust incorporation of the beta Gal gene was seen in the striatum of all three monkeys. Stereological counts revealed that 930,218; 1,192,359; and 1,501,217 cells in the striatum were beta Gal positive in monkeys 1 (n = 2) and 3 (n = 1) months later, respectively. Only the third monkey had an injection placed directly into the substantia nigra and 187,308 beta Gal-positive cells were identified in this animal. The injections induced only minor perivascular cuffing and there was no apparent inflammatory response resulting from the lentivirus injections. Double label experiments revealed that between 80 and 87% of the beta Gal-positive cells were neurons. These data indicate that robust transduction of striatal and nigral cells can occur in the nonhuman primate brain for up to 3 months. Studies are now ongoing testing the ability of lentivirus encoding for dopaminergic trophic factors to augment the nigrostriatal system in nonhuman primate models of Parkinson's disease.

Mechanisms of photoreceptor death and survival in mammalian retina

The mammalian retina, like the rest of the central nervous system, is highly stable and can maintain its structure and function for the full life of the individual, in humans for many decades. Photoreceptor dystrophies are instances of retinal instability. Many are precipitated by genetic mutations and scores of photoreceptor-lethal mutations have now been identified at the codon level. This review explores the factors which make the photoreceptor more vulnerable to small mutations of its proteins than any other cell of the body, and more vulnerable to environmental factors than any other retinal neurone. These factors include the highly specialised structure and function of the photoreceptors, their high appetite for energy, their self-protective mechanisms and the architecture of their energy supply from the choroidal circulation. Particularly important are the properties of the choroidal circulation, especially its fast flow of near-arterial blood and its inability to autoregulate. Mechanisms which make the retina stable and unstable are then reviewed in three different models of retinal degeneration, retinal detachment, photoreceptor dystrophy and light damage. A two stage model of the genesis of photoreceptor dystrophies is proposed, comprising an initial "depletion" stage caused by genetic or environmental insult and a second "late" stage during which oxygen toxicity damages and eventually destroys any photoreceptors which survive the initial depletion. It is a feature of the model that the second "late" stage of retinal dystrophies is driven by oxygen toxicity. The implications of these ideas for therapy of retinal dystrophies are discussed.

[The clinical implications of IgG subclass in 84 patients with autoimmune hemolytic anemia]

OBJECTIVE

To evaluate the clinical implications of IgG subclass in autoimmune hemolytic anemia(AIHA).

METHODS

Data of 84 AIHA patients were retrospectively analyzed.

RESULTS

In the 84 patients, IgG1 + IgG3 + C3d accounted for 45.0%, IgG1 + IgG3 15.5%, IgG1 + C3d 11.0%, C3d 10.7%, IgG1 9.5% and IgG3 + C3d 8.3%. IgG3 patients had the most severity of clinical and laboratory findings, followed by IgG1 patients. In IgG1 and IgG3 subgroups, the severity of hemolysis was positively correlated with the score of Coombs' test. The response rates of IgG3 and IgG1 patients were 68.2% and 100%, respectively.

CONCLUSION

In AIHA, the basic predominant IgG subclass is IgG1. IgG3 has a greater potential for red-cell destruction than IgG1 and C3d.

Assay of 6-mercaptopurine and its metabolites in patient plasma by high-performance liquid chromatography with diode-array detection

A reversed-phase high-performance liquid chromatography (HPLC) method was developed to determine 6-mercaptopurine (MP) and seven of its metabolites (6-thioguanine, 6-thioxanthine, 6-mercaptopurine riboside, 6-thioguanosine, 6-thioxanthine riboside, 6-methylmercaptopurine and 6-methylmercaptopurine riboside) simultaneously in human plasma. A volume of 100 microl of plasma was used. Protein was removed from the sample by a simple and easy ultrafiltration step and ultrafiltrate was directly injected onto the HPLC system. Analytes were detected and confirmed with a diode-array detector before quantitation at 295 and 330 nm. The limit of detection for the analytes ranged from 20 to 50 nM. For the majority of patients receiving a 1 g/m2 MP intravenous infusion, MP and all metabolites except 6-thioguanine and 6-methylmercaptopurine riboside were present. This method serves as useful tool to characterize pharmacokinetics and pharmacodynamics of MP in oncology patients, and the small volume of plasma lends itself to pediatric studies.

Subclasses of warm autoantibody IgG in patients with autoimmune hemolytic anemia and their clinical implications

OBJECTIVE

To explore the mechanism of autoimmune hemolysis and establish a more sensitive test for autoimmune hemolytic anemia (AIHA).

METHODS

IgG subclasses were tested in 40 patients with idiopathic or secondary AIHA by Coombs test with monoclonal antibodies. Hb, TBil, RC and FHb, as hemolytic parameters, were used to analyze the clinical implications of subclasses of AIHA warm autoantibody IgG.

RESULTS

In most patients IgG incomplete warm autoantibody was IgG1 (27 patients), but IgG3 (20 patients), rarely IgG2 (14 patients) and IgG4 (9 patients) also occurred. Three groups were analyzed: Group A included 20 patients with IgG3; Group B included 14 patients with IgG1 bit without IgG3; Group C included 6 patients without IgG1 and IgG3. There were significant differences (P < 0.01) between groups in Hb, TBil, RC and FHb. Moreover, we also found that the sensitivity of Coombs test with polyclonal antiserums was 90.0%, while that of Coombs test with monoclonal antibodies was 97.5%. The effect of treatment was worst in patients with positive IgG3 autoantibody, whose hemolysis recurred frequently.

CONCLUSION

IgG3 autoantibody was the most effective in bringing about red cell destruction, IgG1 autoantibody was less effective, IgG2 even less, whereas IgG4 autoantibody was shown to hardly affect red cell survival. Coombs test with monoclonal antibodies was more sensitive than that with polyclonal antiserums. Patients' respondence to treatment correlated with the type of IgG subclasses.

Anti-inflammatory effects of total saponins of Panax notoginseng

AIM

To study the anti-inflammatory effects of total saponins of Panax notoginseng (PnS).

METHODS

Rat air-pouch acute inflammatory model was established with s.c. carrageenan (Car, 25 mg.kg-1). The protein content in exudate was measured. Micro-acid titration assay and radioimmunoassay (RIA) were applied respectively to investigate effects of PnS on phospholipase A2 (PLA2) activity and dinoprostone (Din) content in exudate. Fura-2 fluorescence technique was used to determine the intracellular free calcium concentration in neutrophils (Neu-[Ca2+]i).

RESULTS

At 12 h, PnS 60-240 mg.kg-1 i.p. reduced Neu counts, protein content [(7.7 +/- 1.3) to (4.4 +/- 1.4) g.L-1], and Din content [(1619 +/- 391) to (883 +/- 268) ng.L-1]; inhibited the PLA2 activity in exudate [(248 +/- 42) to (157 +/- 35) kU.L-1] in a dose-dependent manner. PnS 60, 120, and 240 mg.kg-1 lowered the level of Neu-[Ca2+]i with the inhibitory rate of 9.1%, 33.2%, and 39.4%, respectively.

CONCLUSION

PnS has an obvious anti-inflammatory effect and its mechanisms are related to the inhibition of the Neu-[Ca2+]i level and PLA2 activity, and reduction of Din content.

Localization of IgG in the normal and dystrophic rat retina after laser lesions

PURPOSE

To test the hypothesis that access to extravasated plasma protein IgG may influence photoreceptor survival following laser photocoagulation and to determine whether this correlates with the retinal glial reaction.

METHODS

A total of 45 rats (18 Royal College of Surgeons (RCS) dystrophic and 18 RCS-rdy+ congenic control) were used for this experiment. Nine non-lasered littermates of same age were used as controls. The superior retinas of postnatal day 23 rats were irradiated with a grid pattern of 40 argon green laser lesions of 50 microm in diameter and two powers (150 and 300 mW) for 0.2 s. At various times after laser lesions (up to 14 days), animals were perfused, the retinas snap frozen and sectioned on a cryostat. A one-step immunohistochemical technique was used by incubating with rabbit anti-rat IgG conjugated directly to horseradish peroxidase. Adjacent sections were processed using an antibody to glial fibrillary acidic protein (GFAP) by the standard avidin-biotin complex method.

RESULTS

The labelling pattern for extravasated IgG after laser lesion was very similar in both RCS and RCS-rdy+ rat retinas. At 6, 12 and 24 h after lesions, IgG immunoreactivity (IR) was very intense in the lesion core and flanks. The outer plexiform layer (OPL) and photoreceptor inner segments provided a ready pathway for lateral spread of IgG. However, in the outer nuclear layer (ONL), IgG localization was much more restricted. Despite very intense IgG IR in the ONL of the coagulated lesion core, there was always a very sharply delineated boundary where the label abruptly halted. The GFAP labelling in both RCS dystrophic and RCS-rdy+ congenic control rat retinas showed that this boundary was between normal and necrotic cells because there was a core where GFAP was not produced by Müller cells. By 2 days after lesions, the coagulated cells in the lesion core were being removed by phagocytic cells that were IgG IR. Labelled phagocytic cells were also found among the inner and outer segment region on the lesion flanks. There was still IgG IR in the lesion, but the label was faint. No IgG IR was found in the retina at 3, 4, 7 and 14 days after lesions. Absorption control with pure rat IgG showed the label to be specific.

CONCLUSIONS

The extravasated IgG was derived from the choroidal circulation because at no stage was IgG localized around the retinal vasculature. The IgG labelling was surprisingly widespread and, therefore, did not correlate with photoreceptor sparing, although it preceded the widespread Müller cell expression of GFAP and may, therefore, trigger glial reaction.

[Antilymphocyte globulin combining with cyclosporine A in the treatment of severe aplastic anemia]

OBJECTIVE

To explore more effective regimen for severe aplastic anemia (SAA).

METHODS

A prospective, randomized clinical trial was conducted to determine whether the outcome of SAA patients treated with the combination of antilymphocyte globulin(ALG) and cyclosporine A(CsA) (intensive immunosuppressive therapy, IIST) was better than that with ALG alone (non-intensive immunosuppressive therapy, NIIST).

RESULTS

The response rate of IIST group(83.7%) was significantly higher than that of NIIST group(57.6%), with a lower risk of early mortality and a shorter time to red cell transfusion independence. Furthermore, the recovery of bone marrow BFU-E and CFU-GM of the responding patients was more complete in IIST group than in NIIST group.

CONCLUSIONS

The treatment outcome was better with IIST than with NIIST for SAA.

Examining the immune response in sentinel lymph nodes of mice and men

Recently, it was recognized that an immune response develops along one of two major pathways. One leads to a destructive immune response (type 1), while the alternative leads to a nondestructive immune response (type 2). Our studies in animal models suggest that therapeutic vaccines induce a tumor-specific type 1 immune response while ineffective vaccines induce a type 2 response. These results have led us to examine the immune response in sentinel lymph nodes draining tumor vaccines of patients entered onto clinical trials for melanoma, breast and renal cell cancer.

[Clinical analysis of 164 cases Coombs test positive autoimmune hemolytic anemia]

OBJECTIVE

To analyze the clinical features and treatment outcomes of autoimmune hemolytic anemia (AIHA).

METHODS

Coombs test positive AIHA patients were retrospectively analyzed.

RESULTS

Patients with AIHA were predominantly female, secondary AIHA accounted for 49% of the total cases, mainly associated with connective tissue diseases. In most cases of AIHA, the anti-red cell antibodies were IgG plus C3, while patients with IgG plus IgM had more severe clinical manifestations. The response rate of adrenocortical hormones and cyclosporin A (CsA) was 90.9%.

CONCLUSION

Adrenocorticosteroids is still the first choice of therapy for AIHA, CsA can improve the response rate.

Treatment of severe aplastic anemia with an immunosuppressive agent plus recombinant human granulocyte-macrophage colony-stimulating factor and erythropoietin

To evaluate the therapeutic potential of hematopoietic growth factors (HGFs) during immunosuppressive treatment (IST) of severe aplastic anemia (SAA), 38 patients with newly diagnosed SAA received IST alone (group I), or IST plus recombinant human erythropoietin and granulocyte-macrophage colony-stimulating factor (rhEPO + rhGM-CSF) (group II). Eleven patients in each group received antilymphocyte globulin (ALG) for IST, and eight patients in each group received cyclosporine (CSA). Complete remission rates at one year were 26% and 74% for group I and group II patients, respectively. The ALG-treated subgroup showed the greatest differences between treatments. Compared with patients receiving ALG alone, patients treated with ALG plus HGFs had significantly better one-year survival (100% vs. 54.5%, P < 0.05), complete remission rates (91% vs. 36%, P < 0.05), more rapid and complete hematologic recovery, greater reductions in transfusion requirements, and lower infection rates. The data suggest a potential role for rhEPO + rhGM-CSF therapy in SAA patients receiving IST.

Direct gene transfer to the respiratory tract of mice with pure plasmid and lipid-formulated DNA

Direct gene transfer into the respiratory system could be carried out for either therapeutic or immunization purposes. Here we demonstrate that cells in the lung can take up and express plasmid DNA encoding a luciferase reporter gene whether it is administered in naked form or formulated with cationic liposomes. Depending on the lipid used, the transfection efficiency with liposome-formulated DNA may be higher, the same as, or less than that with pure plasmid DNA. Tetramethyltetraalkylspermine analogs with alkyl groups of 16 or 18 carbons and DMRIE/cholesterol formulations proved particularly effective. Similar results for reporter gene expression in the lung were obtained whether the DNA (naked or lipid formulated) was administered by indirect, noninvasive intranasal delivery (inhaled or instilled) or by invasive, direct intratracheal delivery (injected or via a cannula). Reporter gene expression peaks around 4 days, then falls off dramatically by 9 days. The dose-response is linear, at least up to 100 microg plasmid DNA, suggesting better transfection efficiencies might be realized if there was not a volume limitation. For a given dose of DNA, the best results are obtained when the DNA is mixed with the minimum amount of lipid that can complex it completely. These results are discussed in the context of direct gene transfer for either gene therapy or delivery of a mucosal DNA vaccine.

Cationic polymer and lipids enhance adenovirus-mediated gene transfer to rabbit carotid artery

BACKGROUND AND PURPOSE

Improvement of efficiency of gene transfer to endothelium could be useful for several applications. We tested the hypothesis that cationic nonviral molecules augment adenovirus-mediated gene transfer to blood vessels, perhaps by alteration of the surface charge of adenovirus and facilitation of binding to endothelium.

METHODS

Carotid arteries from rabbits were incubated in vitro for 0.5 to 2 hours with an adenoviral vector alone or noncovalent complexes of adenovirus with poly-L-lysine (a cationic polymer) or lipofectin (a cationic lipid). Binding of adenovirus to the vessels was evaluated immediately after incubation with virus, and assay of transgene (ss-galactosidase) activity and histochemistry were performed 24 hours after gene transfer. To determine whether cationic molecules can be used to augment alteration of vascular function by adenovirus-mediated gene transfer, we also examined effects on gene transfer of endothelial nitric oxide synthase.

RESULTS

Assay of ss-galactosidase activity indicated that both cationic molecules increased transgene expression in vessels by approximately 5- to 6-fold. In contrast, when endothelium was removed from the vessels after gene transfer, poly-L-lysine and lipofectin did not significantly increase transgene activity. Histochemistry for ss-galactosidase also suggested that the adenovirus-cationic molecule complexes augmented transgene expression mainly in the endothelium. In addition, we found that complexing adenovirus with cationic molecules increased binding of adenovirus to the vessels. After gene transfer with recombinant adenovirus containing endothelial nitric oxide synthase, calcium ionophore (A23187) produced greater relaxation of vessels treated with adenovirus complexed with poly-L-lysine or lipofectin than those treated with adenovirus alone.

CONCLUSIONS

Cationic molecules improve the efficiency of adenovirus-mediated gene transfer to blood vessels.

Study of the relatedness of isolates of Shigella flexneri and Shigella sonnei obtained in 1986 and 1987 and in 1994 and 1995 from Hong Kong

We used pulsed-field gel electrophoresis (PFGE) to study the genetic relatedness of 235 isolates of Shigella flexneri and Shigella sonnei collected in Hong Kong (97 isolates from 1986 and 1987 and 138 isolates from 1994 and 1995). Altogether, 13 gels were run with bacteriophage lambda ladder DNA (Pharmacia) as an external reference in every sixth lane, standardized reagents and methods, and isolates randomized for species and years. For quantitative illustration of the relationships within a large body of isolates, computer-generated dendrograms were used to determine the number of isolates in pulsotypes at Dice coefficients of similarity of 75% (PT75) and 50% (PT50). For S. flexneri, there was a significant difference in the distribution of isolates collected during the two periods in both PT75 and PT50, with 68% of isolates collected in 1994 and 1995 sharing a coefficient of similarity of >/=68%. For S. sonnei, a significant difference was observed in PT50 only. We also used Upholt's formula for an approximation of the fraction of nucleotide difference between isolates and Molecular Evolutionary Genetics Analysis to determine relative genetic distances. For both species, the relative genetic distances between isolates of the earlier collection period were significantly greater (P < 0.0001), i. e., they were further apart and therefore more diverse than those of the later period. We conclude that it is possible for a typical clinical laboratory to analyze a large amount of PFGE information on Shigella isolates obtained under controlled conditions. Such data analysis should enhance surveillance capabilities and give indications of further work to be done on various aspects of bacterial pathogenicity of the species.

[Experimental study of dahuang zhechong pills in the treatment of immunological liver fibrosis in rats]

OBJECTIVE

To study the effect of DHZC on liver fibrosis.

METHOD

Immuno-injured fibrosis in rats was induced by bovine serum albumin and DHZC was given during and after the model production respectively. Hepatic collagen contents, pathology of liver and serum hyaluronic acid were measured. Colchicine was used as control.

RESULT

It shows that the liver fibrosis rates of the DHZC treated group during and after the model production were 72.7% and 71.2% respectively, while those of the untreated and colchicine group were 92.3%-100%. Compared with the untreated group, there was a remarkable decrease of hepatic collagen contents in the DHZC-treated rats.

CONCLUSION

DHZC have thus been proved helpful in reversing liver fibrosis to some extent.

Vascular effects of LPS in mice deficient in expression of the gene for inducible nitric oxide synthase

The inducible isoform of nitric oxide synthase (iNOS) is expressed after systemic administration of lipopolysaccharide (LPS). The importance of expression of iNOS in blood vessels is poorly defined. Because nitric oxide from iNOS may alter vasomotor function, we examined effects of LPS on vasomotor function in carotid arteries from iNOS-deficient mice. We studied contraction of the carotid artery from wild-type and iNOS-deficient mice in vitro 12 h after injection of LPS (20 mg/kg ip). Contractile responses to PGF2alpha (3-30 microM) and thromboxane A2 analog (U-46619; 3-100 nM) were evaluated using vascular rings from mice treated with vehicle or LPS. Maximum force of contraction generated by rings in response to PGF2alpha was 0.39 +/- 0.02 and 0.25 +/- 0.01 (SE) g (n = 14) in vehicle and LPS-treated wild-type mice, respectively (P < 0.001 vs. vehicle). Thus LPS reduced constrictor responses in wild-type mice. Thiocitrulline and aminoguanidine (inhibitors of iNOS) improved contractile responses from LPS-treated wild-type vessels. Indomethacin also improved constrictor responses in arteries from wild-type mice injected with LPS. In contrast, contraction of the carotid arteries in response to PGF2alpha and U-46619 was not impaired in LPS-treated iNOS-deficient mice, and contraction was not altered by inhibitors of iNOS. Expression of iNOS mRNA was confirmed using RT-PCR in carotid arteries from wild-type mice after injection of LPS but not vehicle. PCR products for iNOS were not observed in iNOS-deficient mice. These findings provide the first direct evidence that iNOS mediates impairment of vascular contraction after treatment with LPS.