Influence of blood transfusion on postoperative long-term liver function in patients with hepatocellular carcinoma

BACKGROUND/AIMS

To research for possible adverse effects of blood transfusion on liver function at a relatively long term after hepatic resection, liver function tests at one and two years after the surgery were studied in patients with hepatocellular carcinoma.

MATERIALS AND METHODS

Seventy-one patients with no evidence of cancer recurrence during two years after the surgery were selected for this retrospective analysis. Patients were divided into two groups depending on perioperative blood transfusion: those who received blood transfusion (BT(+), n = 38), and those without blood transfusion (BT(-), n = 33).

RESULTS

There were no statistical difference in the preoperative clinical features including liver function tests except decreased prothrombin time index (P < 0.01) and larger amount of intraoperative blood loss (P < 0.01) in BT(+) group. Platelet counts at 2 year after the surgery were significantly higher in the BT(-) group (P < 0.05). Two-way ANOVA showed no significant difference in liver function tests between the two groups. In multiple regression analysis, blood transfusion significantly correlated with serum total bilirubin at 1 year, but did not at 2 years after the surgery.

CONCLUSIONS

The influence of blood transfusion in the patients with hepatocellular carcinoma was considered to be minimum within 2 years after hepatectomy.

Comparative pharmacokinetics of four cholinesterase inhibitors in rats

Pharmacokinetics of a very short-acting, a short-acting and two long-acting cholinesterase (ChE) inhibitors, edrophonium, neostigmine, pyridostigmine and ambenonium, respectively, were compared to elucidate the major determinant of their pharmacokinetics. No dose-dependency in pharmacokinetic behavior was observed within the range of 2-10 mumol/kg for edrophonium, 0.5-2 mumol/kg for pyridostigmine, 0.1-0.5 mumol/kg for neostigmine and 0.3-3 mumol/kg for ambenonium, respectively. Neostigmine has the shortest elimination half-life, and edrophonium, pyridostigmine and ambenonium follow in that. Four ChE inhibitors have similar Vdss values within the range of 0.3-0.7 l/kg, which is similar to the muscle/plasma concentration ratio of these drugs. The liver or kidney to plasma concentration ratio of all ChE inhibitors at 20min after i.v. administration ranged from 5 to 15. Small distribution volumes estimated from the plasma concentration profiles may reflect the distribution to muscle and to the extracellular space of other organs/tissues, while the rapid disappearance of ChE inhibitors from plasma may reflect the concentrative uptake to the liver and kidney.

The role of interleukin-6, interleukin-16, tumor necrosis factor-alpha and endotoxin in hepatic resection

BACKGROUND/AIMS

The role of cytokines was investigated in patients undergoing hepatic resection.

MATERIALS AND METHODS

Cytokines such as interleukin-16, interleukin-6 and tumor necrosis factor-alpha were serially measured both before and after hepatic resection.

RESULTS

The levels of interleukin-16 and interleukin-6 increased immediately after operation, while that of tumor necrosis factor-alpha was only slightly elevated. The increase in interleukin-6 was more prominent than that in interleukin-16. The level of urinary polyamine was elevated at postoperative day 1, while the level of C-reactive protein reached a peak at postoperative day 3. Moreover, no endotoxin in either the peripheral or portal vein was ever detected in this series. Regarding the comparison between major (more than 2 segments) and minor (less than 1 segment) resections, no significant difference was found in the levels of interleukin-1 beta, interleukin-6 or urinary polyamine.

CONCLUSIONS

Therefore, interleukin-6 is considered to be a more sensitive marker of surgical stress than interleukin-1 beta and CRP, while both interleukin-6 and interleukin-16 are suggested to induce hepatic regeneration and the production of acute phase protein in the liver. Furthermore, the absence of any correlation between the volume resected and those cytokine levels suggests that some other as yet unidentified mechanism could be also related to the regulation of hepatic regeneration.

Progressive intraventricular drop of early diastolic flow velocity reflects impaired active ventricular diastolic function in hypertensive heart disease: comparative study between early diastolic and atrial contraction phases

Left ventricular (LV) diastolic function in the early diastolic phase includes both active and passive processes, but in the atrial contraction phase it includes only passive processes. To elucidate the relation between the intraventricular dispersion of the flow velocity in diastole and LV diastolic process, 31 normal volunteers and 12 patients with hypertensive heart disease were studied. In these subjects the flow velocity pattern at the mitral tip was recorded simultaneously with regional flow velocity patterns 1, 2, or 3 cm from the mitral tip toward the apex, respectively, with multigate pulsed Doppler echocardiography from the apical long-axis view with the guidance of Doppler color-flow imaging. Although the ratio of regional peak flow velocity/mitral peak flow velocity in the atrial contraction phase decreased from the mitral tip to the apex to the same degree in the normal volunteers and patients with hypertensive heart disease, there was a significant difference in the intraventricular dispersion of the early diastolic flow velocity between the two groups. These results suggest that the progressive intraventricular drop of the flow velocity in the early diastolic phase in patients with hypertensive heart disease may reflect the impairment of active rather than passive LV diastolic function.

Monocyte-related cytokines in acute myocardial infarction

To elucidate the role of monocytes in the cytokine system in acute myocardial infarction (AMI), we examined the time courses of plasma concentrations and generation capacities of monocyte-related cytokines in 17 consecutive patients with uncomplicated AMI (from day 1 to 28) and in 10 control subjects. The concentrations of monocyte-related cytokines were measured by enzyme immunoassay with horseradish peroxidase. Cytokine generation capacity was evaluated by cytokine concentrations in the culture solution 24 hours after incubation of 0.5 ml whole blood with 5 micrograms lipopolysaccharide. Two distinct patterns of increases in the cytokine concentrations were noted: transient (plasma interleukin [IL]-6) and sustained (plasma macrophage colony-stimulating factor and generation capacities of IL-1 alpha, IL-6, granulocyte colony-stimulating factor, and tumor necrosis factor alpha). There was no significant increase in the concentrations of other cytokines. These results indicate that the concentrations of the monocyte-related cytokines dynamically change during the course of AMI, suggesting that they may contribute to the inflammatory and subsequent proliferative responses in AMI.

[Intra-arterial infusion chemotherapy for advanced liver metastases from lung cancer via implantable vascular access: report of six cases]

Six patients with advanced liver metastases judged as a survival limiting factor from lung cancer were treated with intra-arterial infusion chemotherapy employing totally implantable vascular access. The treatment regimen included 5-FU/CDDP/EPIR/MMC/etoposide in various combinations and this therapy was repeated as long as possible. There were no serious side-effects or complications, such as bone marrow suppression or gastrointestinal symptoms. The therapy could be continued for a mean duration of 7.2 months (ranging from 2 to 13 months). Cause of death was due to extra-hepatic lesion in all 5 patients. The direct effect on liver metastases reviewed on CT scan was 83.3% (CR: 1, PR: 4, NC: 1), and the median survival period was 108 days (for small-cell group: 92 days; for non-small-cell group: 407 days). We conclude that this therapy is useful in the treatment of liver metastases from lung cancer because of its limited toxicity and high direct effect.

Exon redefinition by a point mutation within exon 5 of the glucose-6-phosphatase gene is the major cause of glycogen storage disease type 1a in Japan

Glycogen storage disease (GSD) type 1a (von Gierke disease) is an autosomal recessive disorder caused by a deficiency in microsomal glucose-6-phosphatase (G6Pase). We have identified a novel mutation in the G6Pase gene of a individual with GSD type 1a. The cDNA from the patient's liver revealed a 91-nt deletion in exon 5. The genomic DNA from the patient's white blood cells revealed no deletion or mutation at the splicing junction of intron 4 and exon 5. The 3' splicing occurred 91 bp from the 5' site of exon 5 (at position 732 in the coding region), causing a substitution of a single nucleotide (G to T) at position 727 in the coding region. Further confirmation of the missplicing was obtained by transient expression of allelic minigene constructs into animal cells. Another eight unrelated families of nine Japanese patients were all found to have this mutation. This mutation is a new type of splicing mutation in the G6Pase gene, and 91% of patients and carriers suffering from GSD1a in Japan are detectable with this splicing mutation.

High-powered green light generation by intracavity frequency doubling using grating feedback optics

Grating feedback optics is shown to contribute to narrowing the spectral bandwidth of a multilongitudinal-mode laser diode to less than 0.2 nm and tuning the lasing wavelength to the peak absorption wavelength of Nd:YVO(4). A continuous green light of 31 mW was efficiently generated by intracavity frequency doubling of the Nd:YVO(4) laser with a KTiOPO(4) crystal. A relative intensity noise of less than -140 dB/Hz was obtained in the frequency region greater than 2 MHz. The noise characteristics of generated green light are discussed as compared with the case of using a single-longitudinal-mode laser diode as the pumping source.

Activation induces dephosphorylation of cofilin and its translocation to plasma membranes in neutrophil-like differentiated HL-60 cells

We suggested that a cytosolic 21-kDa phosphoprotein played an important role in opsonized zymosan-trigered activation of superoxide-generating enzyme in neutrophil-like HL-60 cells through dephosphorylation (Suzuki, K., Yamaguchi, T., Oshizawa, T., Yamamoto, Y., Nishimaki-Mogami, T., Hayakawa, T., and Takahashi, A (1995) Biochim. Biophys. Acta 1266, 261-267). In the present study, we characterized the phosphoprotein and studied changes in it localization upon activation of phagocytes. The 21-kDa phosphoprotein was rapidly dephosphorylated upon activation not only wit opsonized zymosan but also with formyl-Met-Leu-Phe and arachidonic acid. The peptide fragments derived from the 21-kDa phosphoprotein were found to have the same amino acid sequences as those of cofilin, an actin-binding protein. The phosphoprotein reacted exclusively with anti-cofilin antibody on two dimensional immunoblots. Accordingly, together with its apparent molecular weight, isoelectric point, and detection of phosphoserine as a phosphoamino acid, we concluded that the 21-kDa phosphoprotein was a phosphorylated form of cofilin. The amount of cofilin in membranous fractions was increased upon activation. Furthermore, confocal laser scanning microscopy showed that cofilin existed diffusely in the cytosol and nuclear region of the resting cells, while in the activated cells, it was accumulated at the plasma membrane area, forming ruffles or endocytic vesicles on which O2.- should be produced. These results suggested that in resting cells cofilin exists as a soluble phosphoprotein in the cytosol and nuclei, while upon stimulation a large portion of cofilin is dephosphorylated and translocated to the plasma membrane regions.

Mutational specificity of the ferrous ion in a supF gene of Escherichia coli

A plasmid, pZ189, was treated with Fe2+/EDTA, and mutagenesis was determined by DNA sequencing. In the fgp+ Escherichia coli host, 78% were base substitutions, with G:C- > C:G transversion (58.7%) predominant, followed by G:C- > T:A transversion (28.3%). In the fpg-1 mutant, 88% were base substitutions among which 46% were G:C- > C:G and 42% G:C- > T:A. Fe2+ resulted in increased formation of 8-hydroxydeoxyguanosine (8-ohdG) in pZ189 DNA. The origin of Fe(2+)-induced G:C- > T:A transversion may be 8-ohdG; on the other hand, the origin of G:C- > C:G is neither 8-ohdG nor 2,6-diamino-4-hydroxy-5-formamidopyrimidine.

Kinetics of 125I-PDGF binding and down-regulation of PDGF receptor in human arterial smooth muscle cell strains during cellular senescence in vitro

Platelet-derived growth factor (PDGF) is one of the major mitogens in serum to stimulate replication of human smooth muscle cells (SMCs) in culture. Previous studies using human fibroblasts failed to demonstrate changes in the receptor systems for growth factors during cellular senescence. We investigated the kinetics of 125I-PDGF(-BB) binding and down-regulation of the PDGF receptor in three human arterial SMC strains during cellular aging. The number of specific 125I-PDGF binding sites per cell increased slightly at a population doubling level (PDL) of 60%-80% of life span and then decreased at the PDL above 90%. The number of receptors per cell-surface area decreased with increasing in vitro age. The apparent Kd for the 125I-PDGF binding decreased with in vitro senescence. The internalization and degradation of 125I-PDGF per receptor were significantly reduced in senescent SMCs and the amount of 125I-PDGF that escaped degradation and was recycled back to the cell surface was significantly greater in senescent SMCs than young cells. Furthermore, down-regulation of the PDGF receptor was significantly greater in senescent SMCs than young cells. Immunoblot studies demonstrated that changes in beta-subunit of the PDGF receptor accounted for those in the studies using 125I-PDGF and that tyrosine phosphorylation of the PDGF receptor was significantly greater in young SMCs than aged cells. Our results suggest that age-related changes in the receptor systems for PDGF may be important contributors to the failure of DNA synthesis in senescent SMCs.

Epidural anesthesia modifies cardiovascular responses to severe hypoxia in dogs

Hypoxia is a critical and sometimes fatal complication of anesthesia. Since there is little information on the cardiovascular response to hypoxia during epidural anesthesia, we assessed the effects of epidural anesthesia on the cardiovascular response to hypoxia and on survival in dogs. We randomly assigned 36 mongrel dogs to one of three groups according to the anesthetic technique used: the thoracic group (n = 12) received thoracic epidural anesthesia plus general anesthesia, the thoracolumbar group (n = 12) received thoracolumbar epidural anesthesia plus general anesthesia, and the control group (n = 12) received general anesthesia alone. We monitored hemodynamics and plasma catecholamine concentrations and assessed survival in these groups during normocapnic hypoxia (FiO2, 0.09 for 120 min). During hypoxic challenge, PaCO2 and PaO2 values were similar in all groups. In both groups that received epidural anesthesia, heart rate, systolic and diastolic arterial pressures, and plasma epinephrine and norepinephrine concentrations were lower and arterial pH was greater than in the control group. There was no significant difference in survival among groups. Epidural anesthesia modified both the physiologic cardiovascular and catecholamine responses to hypoxia. Epidural anesthesia of the thoracic region did not appear to accelerate cardiac arrest, but it attenuated the development of metabolic acidosis during hypoxia.

N-ras and p53 gene mutations are very rare events in multiple myeloma

The frequencies of p53 and N-ras gene mutations were examined in multiple myeloma. DNA samples of 45 cases of multiple myeloma were obtained from stored bone marrow smears. All samples were analyzed for the N-ras gene at codon 12 by the allele specific restriction analysis method and at codon 61 by direct sequencing. DNA was screened for mutations by single-strand conformation polymorphism analysis for the p53 gene in exons 5 to 8. DNA fragments showing an altered electrophoretic pattern were further studied by direct sequencing to confirm the mutations. Ras mutations were found in two cases at codon 61 (4.4%). A point mutation of the p53 gene was detected in one of 45 cases (2.2%). These 3 cases with mutations were in an advanced stage. In conclusion, N-ras and p53 gene mutations may occur at a late stage of multiple myeloma, but the frequencies of the mutations are very low.

Regulation of interleukin 6 in multiple myeloma and bone marrow stromal cells

We and others have shown that some freshly isolated multiple myeloma (MM) cells and derived cell lines express interleukin 6 (IL-6) receptors and proliferate in vitro in response to IL-6; a subset of MM cells also expresses IL-6 mRNA, is intracytoplasmic IL-6 positive and secretes IL-6. We have shown that MM cells express the cell surface adhesion molecules CD29/CDw49d(VLA-4), CD18/CD11a(LFA-1) and CD44, and may localize to marrow via specific adherence to both extracellular matrix proteins and to bone marrow stromal cells (BMSCs). MM cell adhesion triggers IL-6 secretion by normal and MM BMSCs and related IL-6-mediated tumor cell growth. Our attempts to block MM cell adhesion to BMSC-induced IL-6 secretion by using antibodies to CD29/CDw49d, CD18/11a, and/or CD44 demonstrated minimal effects, suggesting that another ligand-receptor interaction triggers IL-6 secretion when MM cells and BMSCs are juxtaposed. Both MM cells and BMSCs express CD40. Triggering of MM cells and BMSCs via CD40 upregulates IL-6 secretion in both MM cells and MM-derived cell lines, as well as BMSCs and BMSC lines, suggesting the possibility of both autocrine and paracrine MM cell growth triggered via CD40. Finally, experiments using the LP 101 BMSC line transiently transfected with IL-6 promoter fragments linked to chloramphenicol acetyltransferase reporter gene demonstrate that adhesion of MM cells induces IL-6 gene transcription in BMSCs, which is conferred via the NF-kappa B binding motif.(ABSTRACT TRUNCATED AT 250 WORDS)

Monoclonal antibody developed against a hemolysin of Bacillus thuringiensis

A total of five hybridoma cell lines that produced monoclonal antibodies (MAb) against a hemolysin (Bt-hemolysin) produced by Bacillus thuringiensis were established and characterized. All of these monoclonal antibodies reacted similarly not only to Bt-hemolysin but also to a hemolysin (Bc-hemolysin) produced by B. cereus, suggesting that the two hemolysins are immunologically indistinguishable. The MAb developed in this study was also successfully applied for rapid and simple purification of both Bt- and Bc-hemolysins by immunoaffinity column chromatography. The partial N-terminal amino acid sequence of the purified hemolysins was determined to be Ile-Glu-Gln-Thr.

Rapid detection of mycoplasma contamination in cell cultures by enzymatic detection of polymerase chain reaction (PCR) products

Enzymatic detection of polymerase chain reaction (ED-PCR) was applied for rapid and easy identification of mycoplasmas from contaminated cell culture. This method was based on the capture of amplified products via biotin-streptavidine affinity and the detection of an incorporated hapten in amplified products with enzyme-linked antibody. Primers corresponding to common sequence of Mollicutes in 16S ribosomal RNA dominated gene was used. Nineteen of twenty Mollicutes so far reported as cell contaminants appeared positive by ED-PCR, whereas remaining one, Acholeplasma axanthum, appeared negative. Samples from sixty-two cell culture were tested for contamination of mycoplasmas by means of ED-PCR, cultivation, and electronmicroscopy. The results of ED-PCR were the same as those of cultivating method. The time required for all the detection process in ED-PCR was about 5 hr for 20 samples. We suggest that ED-PCR can be used in the rapid detection of mycoplasms from cell culture.

Serum concentrations of 5-fluorouracil achieved with nocturnal constant-rate infusion in patients with disseminated cancer

Nocturnal infusion of 5-fluorouracil (FUra) was performed in nine patients with disseminated cancer. Three gastric, three colon and three breast cancer patients were administered 300 mg/m2 FUra continuously for 10 h per day from 2100 h to 0700 h for more than 20 consecutive days. In the first three patients, who were treated by drip infusion without the use of a volumetric pump, serum FUra concentrations ranged widely, from 27 to 130 ng/ml, even though the rate of administration was re-adjusted four times during the night. The last six patients were treated using a volumetric pump, and FUra concentrations in serum ranged from 175 to 378 ng/ml, and displayed no circadian rhythm. Although the dose intensity and area under the curve of FUra in these patients were high, neither myelosuppression nor other side effects were observed.

Mass screening and age-specific incidence of neuroblastoma in Saitama Prefecture, Japan

PURPOSE

To provide the population-based incidence rate of neuroblastoma and to determine the effect of mass screening on the annual age-specific incidence of the tumor in Saitama Prefecture, Japan, from 1981 to 1992.

METHODS

Data on screened infants and patients detected by the screening were obtained from the records of the Prefectural Screening Center. Data on neuroblastomas in this area were obtained from the Children's Cancer Registry of the Saitama Prefectural Government (Prefectural Registry) and from the Japan Children's Cancer Registry (National Registry). Population data were obtained from the Prefectural Census. Mass screening for 6-month-old infants was performed by qualitative assessment of urinary vanillylmandelic acid (VMA) from June 1981 to September 1989 and by quantitative measurement of VMA/creatinine (Cre) and homovanillic acid (HVA)/Cre from October 1989 to December 1992.

RESULTS

Between 1981 and 1992, 199 cases of neuroblastoma, which include 74 cases detected by mass screening, were identified in Saitama Prefecture. The incidence rate for children under 15 years of age increased from 6.4/10(6) to 20.1/10(6), that for children 0 to 4 years of age increased from 17.0/10(6) to 64.1/10(6), and that for infants under 1 year of age increased from 27.9/10(6) to 260.4/10(6) during these 12 years. No significant reduction in the incidence rate was observed for children over 1 year of age.

CONCLUSION

The incidence rate for children under 15 years of age increased with mass screening. The rate for infants was sharply increased, with no corresponding decrease in the rate for children at older ages. These data suggest that there is a subset of neuroblastoma that can be detected by mass screening at 6 months of age but would not be diagnosed later clinically.

Gel chromatographic analysis of cyclosporin and its metabolites in human blood compartments

Gel chromatography combined with specific and non-specific cyclosporin radioimmunoassays was adopted for quantitative analysis of cyclosporin and metabolites in free and protein-bound forms in blood compartments of kidney transplant patients. The analytical method was proved to be useful for the purpose, although plasma protein-bound forms of neither cyclosporin nor metabolites could be quantitated in the system. The present study also provided, by gel chromatographic analysis, additional examples to prove that concentrations of cyclosporin metabolites in blood compartments may not be deduced or inferred simply from those of cyclosporin.

Undifferentiated carcinoma of the duodenal ampulla

This report demonstrates a case of undifferentiated carcinoma of the duodenal ampulla. A 74-year male experienced jaundice lasting for 3 weeks. An upper gastrointestinal series demonstrated a polypoid, ovoid filling defect in the second portion of the duodenum, and duodenoscopy disclosed a protruding mass involving the orifice of the papilla of Vater. Cholangiography demonstrated obstruction due to compression in the terminal common bile duct. Pylorus-preserving pancreatoduodenectomy was performed on the diagnosis of ampullary carcinoma. The gross specimen showed a polypoid mass, measuring 3.5 cm in diameter, in the ampulla, located mainly in the duodenal submucosal layer and invading the terminal common bile duct. Histologically, the tumor was small cell type, undifferentiated carcinoma, arising from the duodenal epithelium adjacent to the ampulla.

Identification of a novel p53 promoter element involved in genotoxic stress-inducible p53 gene expression

p53 is recruited in response to DNA-damaging genotoxic stress and plays an important role in maintaining the integrity of the genome. We show that exposure of cells to various genotoxic agents, including anticancer drugs such as mitomycin and 5-fluorouracil, results in an increase in p53 mRNA levels and in p53 promoter activation, indicating that the p53 genotoxic stress response is partly regulated at the transcriptional level. The results of the p53 promoter analysis show that a novel p53 promoter element, termed a p53 core promoter element (from -70 to -46), is essential for basal p53 promoter activity and promoter activation induced by genotoxic agents such as anticancer drugs and UV. Although a kappa B motif partially overlaps with this element and those genotoxic agents activate NF-kappa B, it does not play a major role in p53 genotoxic stress response: NF-kappa B p65 expression did not induce significant p53 promoter activation, and NF-kappa B inhibitors (N-acetyl cysteine and I kappa B alpha) did not inhibit genotoxic stress-inducible p53 promoter activation. Finally, we characterized nuclear factors, the binding of which to the p53 core promoter element is essential for basal p53 promoter activity and p53 promoter activation induced by genotoxic agents.

[SH/TA-508 clinical phase II study: dose evaluation of SH/TA-508 in echocardiography]

A cooperative study was conducted at 18 institutions to evaluate the safety and usefulness of SH/TA-508, a contrast medium for ultrasound diagnosis, and to find its optimum dose. One hundred and one patients with confirmed or suspected ischemic heart disease were examined with two-dimensional echocardiography, and 95 patients with mild mitral insufficiency were studied with the color Doppler method. The contrast medium was administered at low-dose (1.5-1.6g galactose) and high-dose (3.0-3.2 g galactose) levels at concentrations of 200, 300 and 400 mg/ml. The contrast effect was evaluated into five grades by two-dimensional echocardiography: - (ineffective), + (weak), 2+ (moderate), 3+ (good), 4+ (excessive effect) and into four grades with the color Doppler method, - (ineffective), + (weak), 2+ (optimum), 3+ (excessive effect). The two-dimensional echocardiographic studies showed effects graded at 2+ and above in most patients (83-93%). These findings were significantly more common in patients who had received the 300 and 400 mg/ml concentrations than in those who received the 200 mg/ml concentration. Statistical analysis found no significant differences between the high-dose and low-dose groups. Color Doppler echocardiography found signal enhancement graded at 2+ and above in 80-93% of cases. There were no significant differences in enhancement effect attributable to concentration or total dose. However, since excessive signal intensity was seen quite frequently, the dose levels in the present study were considered to be a little too high. Side effects includes transient feelings of warmth or cold, and the incidence of side effects was higher at higher doses and concentrations. The results show that the optimum concentration for two-dimensional echocardiography is 300 mg/ml and for color Doppler 200 mg/ml. No particular safety problems were seen with SH/TA-508, and this contrast medium is useful in echocardiography of the left ventricle and in enhancing mitral regurgitation signals in color Doppler examinations. Therefore, a phase III multicenter trial should be performed.

Use of a new oligonucleotide probe for detection of colonization factor antigen III gene in enterotoxigenic Escherichia coli

An alkaline phosphatase-labeled 30-mer oligonucleotide probe was designed to detect the gene for pilus colonization factor antigen III (CFA/III) of the human type of enterotoxigenic Escherichia coli (ETEC). The CFA/III probe was used to identify CFA/III-producing ETEC among 303 Escherichia coli obtained from subjects with traveler's diarrhea. Six isolates positive for the CFA/III gene were found. This result was confirmed immunologically by using a specific monoclonal antibody developed against CFA/III. These six isolates, isolated from travelers returning from India, Pakistan and China, were all positive for the gene of heat-labile enterotoxin and possessed an identical serotype (025:H-).