Effects of DX-9065a, an orally active, newly synthesized and specific inhibitor of factor Xa, against experimental disseminated intravascular coagulation in rats

We investigated the protective effects of DX-9065a, an orally active, newly synthesized and specific inhibitor of factor Xa, against two kinds of experimental disseminated intravascular coagulation (DIC) in rats. Endotoxin-induced experimental DIC was induced by a 4-h sustained infusion of endotoxin at a dose of 100 mg/kg. Thromboplastin-induced experimental DIC was induced by a bolus injection of thromboplastin at a dose of 150 mg/kg. The rats were orally administered DX-9065a at 10, 30 or 100 mg/kg 30 min before endotoxin or thromboplastin injection. In both DIC models, DX-9065a showed a protective effect against DIC, at all doses and in all parameters, including fibrin/fibrinogen degradation products (FDP), fibrinogen level, prothrombin time, activated partial thromboplastin time, platelet count and the number of renal glomeruli with fibrin thrombi. When DX-9065a was orally administrated at 100 mg/kg without endotoxin or thromboplastin, no significant changes were seen in hemostatic parameters except PT and APTT, and no fibrin thrombi or abnormal bleeding were seen in renal specimens. These findings suggest that the new oral anti-Xa drug, DX-9065a, has an effect in reducing the severity of DIC. However, further dose-finding and safety studies of this drug have still to be assessed.

A similar expression pattern of adhesion molecules between intermediate TCR cells in the liver and intraepithelial lymphocytes in the intestine

Two major populations of extrathymically differentiated T cells exist in the liver and intestine. Such T cells in the liver have TCR of intermediate intensity (i.e., intermediate TCR cells) and constitutively express IL-2 receptor beta-chain (IL-2R beta), whereas those in the intestine, especially intraepithelial lymphocytes, have TCR of bright intensity, consisting of a mixture of IL-2R beta+ and IL-2R beta-. All mature thymocytes and thymus-derived T cells seen in the peripheral immune organs are TCR-bright+ IL-2R beta- under resting conditions. When the expression pattern of adhesion molecules, including CD44, L-selectin, LFA-1 and ICAM-1, was compared among these T-cell populations, they displayed quite unique patterns of expression. All extrathymic T cells in the liver, intestine, and even other organs were CD44+ L-selectin-LFA-1++ICAM-1+, whereas thymocytes and thymus-derived T cells were CD44-L-selectin+LFA-1+ICAM-1-. This inverted expression of adhesion molecules between extrathymic T cells and thymus-derived T cells might be associated with their unique tissue-localization.

Allelic losses and metastatic ability of mouse tumor cell clones derived from a heterozygous mouse

Some chromosomal or subchromosomal deletions observed in a variety of cancer cells may be related with metastatic properties of the tumor cells. Thus, relationship between allelic losses and metastatic ability is here investigated of ten in vitro clones obtained from 505 cells that are derived from a fibrosarcoma induced in a F1 mouse between C3H and C57BL strains. Allelic loss was examined using 61 microsatellite markers spanning all autosomes and deletions of various loci were observed in all of the clones. One clone showed a metastatic ability higher than the parental 505 cells and the other clones. This particular clone specifically lost a chromosome 16 derived from C57BL, suggesting an association of this chromosome deletion with the metastatic ability. Consistently, examination of metastatic nodules derived from 505 cells and one in vitro clone showed that the cells with deletion of the C57BL chromosome increased in number during metastasis. These results suggest that mouse chromosome 16 may harbor a gene(s) involved in metastasis.

Mechanism of the induction of autoimmune disease by graft-versus-host reaction. Role of CD8+ cells in the development of hepatic and ductal lesions induced by CD4+ cells in MHC class I plus II-different host

BACKGROUND

We previously reported that primary biliary cirrhosis (PBC)-like hepatic lesions were induced in (bm12xB6)F1 mice undergoing graft-versus-host reaction with major histocompatibility complex class II disparity. In this paper, we report on a new experimental system, enabling establishment of more progressed stages of PBC-like lesions and clarification of the role of CD8+ cells in the development of the lesions.

EXPERIMENTAL DESIGN

Recipient (bm12xbm1)F1 mice were thymectomized and administered anti-Lyt-2 monoclonal antibodies intraperitoneally to deplete host CD8+ cells as completely as possible. The treatment was necessary to induce autoimmune hepatic lesions in this type of F1 mice. Recipients were divided into five groups: group 1 received B6 CD4+ cells on day 0 and 2 weeks later, B6 CD8+ cells; group 2, only B6 CD4+ cells on day 0; group 3, only B6 CD8+ cells on day 14; group 4, B6 CD4+ on day 0 plus F1 CD8+ cells 14 days later. Cell transfer was not done in group 5. All of the mice were killed on day 28 for examination by light and electron microscopy and also by immunohistochemistry.

RESULTS

PBC-like hepatic lesions without tissue destruction were induced in the mice of group 2, as was previously reported. In addition to similar lesions to group 2, destruction of hepatocytes and bile duct epithelia was induced in the mice of group 1. Weak lymphocytic infiltration and periductal concentric fibrosis were observed in the mice of group 3. PBC-like hepatic lesions without tissue destruction were induced in mice of group 4 as were those of group 2. However, the cellular infiltration was much weaker.

CONCLUSIONS

For the animal model of PBC, we have devised a new experimental system in which the role of donor or host type CD8+ cells is assessable. Tissue-destructive lesions were induced only in mice that received donor CD4+ cells followed by CD8+ cells. The PBC-like lesions were suppressed by host type CD8+ cells. These results suggest that destructive hepatic lesions of PBC might progress through CD8+ cells in cooperation with CD4+ cells, and that host type CD8+ cells could act as "regulatory" T cells for the progression of the lesions.

Plasma levels of lipoprotein(a) are elevated in patients with the antiphospholipid antibody syndrome

The mechanisms underlying clinical abnormalities associated with the antiphospholipid antibody syndrome (APAS) have not been elucidated. We measured plasma levels of lipoprotein(a) [Lp(a)], the active form of plasminogen activator inhibitor (active PAI), thrombin-antithrombin III complex (TAT) and soluble thrombomodulin (TM), to investigate the relationship of these factors to thrombotic events in APAS. Mean plasma levels of Lp(a), TAT, active PAI and TM were all significantly higher in patients with aPL than in a control group of subjects. Plasma levels of Lp(a) and active PAI were significantly higher in patients with aPL and arterial thromboses than in patients with aPL but only venous thromboses. There was a significant correlation between plasma levels of Lp(a) and active PAI in patients with aPL. These findings suggest that patients with aPL are in hypercoagulable state. High levels of Lp(a) in plasma may impair the fibrinolytic system resulting in thromboses, especially in the arterial system.

[Ultrasonographic blood flow velocimetry in maternal and umbilical arteries during maternal exercise]

To see hemodynamic changes induced by exercise in pregnant women, we performed blood flow velocimetry with an ultrasonic pulsed Doppler in femoral (FA), external carotid (CA), uterine (UA) and umbilical arteries (Umb A) of pregnant women before and after aerobic dancing at an intensity of approximately 65% maximal heart rates. The subjects were 21 volunteer pregnant women at from 34 to 40 weeks of gestation without obstetrical problems. The velocimetry was done at intervals of five minutes for only one artery of the four arteries. The measurement was repeated 4 times. The following results were obtained: (1) Both pulse rates and blood pressure (BP) increased significantly five minutes after the onset of exercise (p < 0.05) and tachycardia continued for 20 minutes. The intensity of exercise was equivalent to 68.8 +/- 1.1% of the maximal heart rates (mean +/- S.E.). (2) Systolic peak velocity in the FA of the pregnant women increased by 130%, flow volume per minute jumped by 337% (p < 0.05), and the pulsatility index (PI) decreased by 80% (p < 0.05). (3) Neither the systolic peak velocity nor the PI of CA and UA changed significantly. (4) The FHR became tachycardic due to exercise from 142.2 +/- 2.5 bpm to 161.1 +/- 3.8 bpm, associated with the increase in maternal pulse rates. (5) The PI of Umb A was decreased from 0.95 +/- 0.04 to 0.80 +/- 0.03 by exercise. The PI showed a negative correlation (r = -0.37, p < 0.05) with the FHR, not different from a correlation shown without exercise.(ABSTRACT TRUNCATED AT 250 WORDS)

Proliferating cell nuclear antigen/cyclin expression in small adenomas of the large intestine in relation to size and macroscopic appearance

Sixty-two colorectal adenomas 10 mm or less in diameter, resected endoscopically and fixed in formalin for 3 days or less, were evaluated with antiproliferating cell nuclear antigen/cyclin (PCNA) monoclonal antibody to investigate the cell proliferation kinetics. All lesions were tubular adenoma with low-grade atypia. These lesions were classified by macroscopic type as: I; polypoid (n = 14), IIa; flat or hemispherically elevated (n = 28), IIb; plain, flat (n = 6), IIc; depressed (n = 9), and IIa+IIc slightly elevated with a central depression (n = 5). The distribution patterns of PCNA-positive cells were divided into two types; diffuse distribution of positive cells throughout the crypts (diffuse type) and localized distribution, mainly in the upper portions of the crypts (superficial type). The distribution pattern of proliferating cells was correlated with the size and macroscopic type of adenoma. Type IIc, IIa+IIc, IIb, smaller (< or = 5 mm) IIa and smaller (5 mm) I adenomas showed the superficial type pattern. Larger (> 5 mm) adenomas of type I and IIa had the diffuse type pattern. The formation of a proliferative zone in small adenomas, as in normal mucosa, but in opposite locations, suggested a lower cell proliferation activity. In the elevated type (I and IIa) adenomas, however, the change in the distribution pattern of proliferating cells from the superficial to the diffuse type would lead to growth in size.

Hepatitis C viral markers in patients who received blood that was positive for hepatitis C virus core antibody, with genetic evidence of hepatitis C virus transmission

BACKGROUND

Despite the use of the anti-c100-3 assay for blood donor screening, posttransfusion non-A,non-B hepatitis still occurred. A more sensitive assay should be developed to prevent this.

STUDY DESIGN AND METHODS

Stored serum specimens from 2020 healthy blood donors who were negative for c100-3 antibody to hepatitis C virus (HCV) were retrospectively screened for the presence of antibodies against a core protein of HCV using an enzyme-linked immunosorbent assay and Western blot analysis as part of a study on posttransfusion non-A,non-B hepatitis.

RESULTS

Eight (0.4%) of the 2020 donors were positive for HCV core antibody. Posttransfusion non-A,non-B hepatitis occurred in 5 of five patients known to have received blood that was positive for HCV core antibody and 1 of 141 patients transfused with blood that was negative for HCV core antibody. The total incidence of posttransfusion non-A,non-B hepatitis was 4.1 percent (6/146). The nucleotide sequence of the nonstructural 5 region of the HCV genome obtained from two donors and corresponding recipients was also analyzed. The HCV genome sequences were identical for one donor-recipient pair, and there was 99.4-percent homology for a second pair.

CONCLUSION

Anti-core-positive blood proved to be highly infectious for HCV, and this validated the use of the second-generation anti-HCV assay for blood donor screening.

Sequence analysis of the proximal promoter region of the human alpha-fetoprotein gene in hepatocellular carcinoma

We have examined whether or not mutations exist in the proximal promoter region of the human alpha-fetoprotein (AFP) gene in the hepatocellular carcinoma (HCC) tissue. Genomic DNA was extracted from four patients: one HCC tissue, one HCC and its corresponding non-cancerous (cirrhosis) tissues, one liver cirrhosis (LC) tissue without HCC and one matching HCC tissue and peripheral blood leukocytes. Serum concentrations of AFP in the patients ranged from less than 5 to 10,138 ng/ml. Nucleotide sequence was determined by direct sequencing using a single-stranded DNA template that was produced first through the polymerase chain reaction (PCR) amplification and then asymmetric PCR. In one HCC tissue taken from the patient with a high concentration of serum AFP, nucleotides different from published ones were detected at -120 and -113. These changes, however, probably reflect a DNA polymorphism, because peripheral blood leukocytes of the same patient had the same changes. Including this patient, no mutations in the region from -160 to -10 were detected in the HCC specimens we have examined. These results suggest that the extremely proximal promoter region of the AFP gene where glucocorticoid-responsive element and HNF-1 binding sites exist is not responsible for the re-expression of AFP in HCC.

Similarities and differences between extrathymic T cells residing in mouse liver and intestine

Extrathymic T cells in the hepatic sinusoids and intraepithelial lymphocytes (IEL) in the intestine of mice have both similar and different properties. In this study, both types of extrathymic T cells in mice were further characterized. Lymphocytes obtained from systemic immune organs, including the lamina propria and Peyer's patches, were also compared. Extrathymic T cells in both the liver and the intestine contained a large proportion of gamma delta T cells and expressed the alpha alpha homodimer of CD8. They became more prominent in athymic nude mice and in normal mice with aging, while disappearing in scid mice. Extrathymic T cells in the liver, on the other hand, had TCR of intermediate intensity (i.e., intermediate TCR cells) and IL-2 receptor beta-chains (IL-2R beta) of high intensity, similar to NK cells, whereas IEL had TCR of bright intensity and consisted of cells with both low and high levels of IL-2R beta. Thymus-derived T cells did not express IL-2R beta at all, at least at their resting conditions. Intermediate TCR cells included double-negative CD4-8- cells as well as single-positive cells. In contrast, IEL contained both double-positive (DP) CD4+8+ cells and single-positive cells. More precisely, IEL gamma delta T cells were mainly IL-2R beta + and single-positive (mainly CD8+), while IEL alpha beta T cells were mainly IL-2R beta- and contained both DP CD4+8+ cells and single-positive cells. CD4+ cells were more predominant than CD8+ cells in the liver, while CD8+ cells were overwhelmingly predominant in the intestine. These results suggest that both intermediate TCR cells and IEL are generated as primitive T cells in phylogeny, but later develop along independent pathways at their respective sites.

Therapeutic effect of a CDDP-epirubicin-Lipiodol emulsion on advanced hepatocellular carcinoma

Prior injection of an anticancer agent and Lipiodol mixture is a key point for the treatment of hepatocellular carcinoma (HCC). We therefore prepared a new, improved emulsion of Lipiodol containing a high dose of cis-diamminedichloroplatinum (CDDP) and epirubicin by replacing the ionic contrast medium (Urografin 67) with a nonionic contrast medium (Iopamidol; Iopamiron 300) and adding phosphatidyl choline. This CDDP-epirubicin-Lipiodol emulsion (CELE) was examined pharmacologically and chemically with the following results. The size of these particles is less than 10 microns (diameter) for up to 24 h; the release of 28%-34% of the CDDP and 80%-90% of the epirubicin was estimated in the dissolution test, and 85% of the CDDP and 35% of the epirubicin was retained in the organs in the moment calculation. CELE was injected into 58 HCC patients via a celiac angiographic catheter. In 36 of these patients, the CELE injection was followed by transcatheter arterial embolization (TAE) therapy. Following the administration of CELE as one-shot injection therapy for stage IV HCC, the 1-year survival rate was 59% and the 2-year survival rate was 27%. Moreover, in patients (stage II, 12; stage III, 8; stage IV, 16) who received CELE and subsequently underwent TAE therapy, the 1-year survival rate was 90% and the 2-year survival rate was 67%. The nonionic contrast medium with Lipiodol forms finer emulsified particles, and these particles are more capable of penetrating into the tumor. In addition, the greater pharmacological stability of these particles provides a slow-release effect and prolonged stability of their shape. Finally, theoretically, the use of two major anticancer agents such as CDDP and epirubicin showed a greater clinical effect in the treatment of HCC than either our earlier suspension or a single anticancer agent.

Relationship between serum IgA levels and CD4 subsets in IgA nephropathy

In this study, the relationship between serum levels of IgA (s-IgA) and CD4 subsets in peripheral blood was investigated in patients with IgA nephropathy (IgA N). We have also recently reported that the percentage of CD4+ CD45RA+ cells was significantly decreased in this disease. Serum levels of immunoglobulins (IgG, IgA, IgM) and the percentage of CD4+CD45RA+ cells or CD4+CD45RO+ cells were measured by two-color analysis in blood samples obtained from 45 patients with IgA N, 30 patients with various glomerulonephritides and 30 healthy volunteers. A significant decrease of CD4+ CD45RA+ cells and a significant increase of CD4+CD45RO+ cells were observed in the IgA N group. Moreover, in the IgA N group, s-IgA correlated negatively with the percentage of CD4+CD45RA+ cells and correlated positively with that of CD4+CD45RO+ cells. After 1 and 2 years, the same analyses were serially performed in 15 nonmedicated patients with IgA N. Similar results concerning the relationship between s-IgA and CD4 subsets were obtained both after 1 and 2 years. The percent changes of s-IgA (delta s-IgA) correlated with delta CD4+CD45RO+ cells: r = -0.66483 (p < 0.01) after 1 year, r = -0.69688 (p < 0.01) after 2 years. On the other hand, delta s-IgA correlated with delta CD4+CD45RA+ cells (p < 0.05) after 1 year, but no after 2 years. It was concluded that s-IgA levels strongly correlate with the percentage of CD4+ CD45RO+ cells in peripheral blood, in patients with IgA N.

Experience with laparoscopic hysterectomy

We conducted laparoscopic hysterectomy on 62 consecutive patients; 12 had laparoscopically assisted vaginal hysterectomy (LAVH), 16 had total laparoscopic hysterectomy (TLH), and 34 had supracervical laparoscopic hysterectomy (SLH). The groups were comparable with regard to age, weight, history of abdominal surgery, number of additional procedures performed, and weight of specimens; 74% had previous abdominal surgery, and 69% had additional procedures at hysterectomy. The mean estimated blood loss associated with LAVH was 2.5 times greater than that with TLH and 3 times greater than with SLH. The length of surgery was influenced by patient selection, surgeon's experience, and equipment malfunction, with a mean of 213 minutes for LAVH, 244 for TLH, and 212 for SLH. The mean hospital stay for LAVH was 1.9 days and less than 1 day for TLH and SLH. There were nine total complications in the series (15%). Twelve (19%) of the specimens showed no abnormalities on pathologic examination. Total and supracervical laparoscopic hysterectomy and LAVH are appropriate operations for selected patients and compare favorably with standard abdominal or vaginal hysterectomy. The procedures demand sophisticated instrumentation and a dedicated endoscopy team to ensure safe and efficient performance.

Detailed characterization of gamma delta T cells within the organs in mice: classification into three groups

gamma delta T cells are known to localize preferentially in the epithelial regions and the hepatic sinusoids, and exhibit highly restricted V gene usage depending on their location. In the present study, gamma delta T cells in mice were further characterized in terms of their expression of the interleukin-2 receptor beta-chain (IL-2R beta), CD4 and CD8, and CD8 alpha and beta. This experiment was arranged to investigate whether gamma delta T cells have different properties depending on the organs and how gamma delta T cells are different from extrathymic alpha beta T cells, i.e. alpha beta T cells in the liver and intraepithelial lymphocytes in the intestine, in terms of the above phenotypes. Three-colour immunofluorescence tests using monoclonal antibodies revealed that gamma delta T cells can be classified into three groups: gamma delta T cells of the liver type are all IL-2R beta+, are comprised of double-negative (DN) CD8-CD4- and single-positive CD8+ (no CD4+) cells, and express CD8 alpha+ beta-; gamma delta T cells of the thymus type are a mixture of IL-2R beta+ and IL-2R beta-, are mainly DN, and express CD8 alpha+ beta+ if they carry CD8 antigens; and gamma delta T cells of the intestine type are also IL-2R beta+ or IL-2R beta-, are all CD8+, and express CD8 alpha+ beta-. gamma delta T cells in the spleen of normal mice are of the thymus type, while gamma delta T cells in the spleen of athymic nude mice seem to be of the liver type. All these properties of gamma delta T cells resemble those of extrathymic alpha beta T cells rather than regular alpha beta T cells of thymic origin. The present results reveal that gamma delta T cells and other extrathymic alpha beta T cells have many properties in common as primitive lymphocytes in phylogenetic development.

Exocrinopathy resembling Sjögren's syndrome induced by a murine retrovirus

BACKGROUND

Sjögren's syndrome (SS) is characterized by lymphocytic infiltration into, and destruction of exocrine glands, resulting in dryness of the mouth and eyes. The disease is considered to have an autoimmune etiology, however, its etiopathogenesis remains largely unknown. Recently, retrovirus is suggested to participate in the pathogenesis of SS, because SS-like lesions are reported in HIV infection or in human T cell leukemia virus type I infection. Moreover, human intracisternal A-type retroviral particles are reported to be detected in SS patients. During the course of our study on the histopathology of mice infected with a murine retrovirus, we happened to find SS-like exocrinopathy in those mice.

EXPERIMENTAL DESIGN

Four-week-old C57BL/6 (B6) mice were injected intraperitoneally with LP-BM5 murine leukemia virus. This virus is known to induce splenomegaly, lymphadenopathy followed by lymphoid malignancy, and profound immunodeficiency in sensitive strains of mice. From 4 to 16 weeks after the virus inoculation, the infected mice were sacrificed and their submandibular and lacrimal glands were analyzed light and electron microscopically and immunohistochemically. The existence of the virus in the lesion in situ was also analyzed by the same method, and additionally by a polymerase chain reaction method.

RESULTS

Periductal lymphocytic infiltration into the submandibular and lacrimal glands was observed in all the virus-infected mice at 4 weeks after the infection and progressed with time. Extraglandular lymphocytic infiltration was also observed in liver, kidney, lung, and pancreas. Immunohistochemical examination revealed that most infiltrating cells into the glands were composed of CD3+ T cells (CD4-dominant), Mac-1+ cells, and B220+ cells. The virus genome was detected in submandibular glands by immunohistochemistry or by polymerase chain reaction. In addition, retroviral particles were secreted into the lumen of exocrine ducts of submandibular glands.

CONCLUSIONS

This might be an SS animal model that is induced by a certain defined retrovirus. This experimental system might provide us with valuable information for analyzing the mechanisms of how a retrovirus could induce SS.

Effects of direct percutaneous transluminal coronary angioplasty treatment of acute myocardial infarction on plasma levels of haemostatic and fibrinolytic factors

Although thrombolytic therapy is used widely for treatment of acute myocardial infarction (AMI), thrombolysis itself increases thrombin activity and may cause reocclusion of infarct-related vessels. Direct percutaneous transluminal coronary angioplasty (PTCA) is an effective treatment for AMI; however, it is not clear what effects PTCA has on coagulation and fibrinolysis. We investigated coagulation and fibrinolytic factor concentrations before and after direct PTCA. Plasma levels of thrombin-antithrombin III complex (TAT), D-dimer, plasmin-(alpha 2-antiplasmin complex (PAP), tissue-type plasminogen activator (t-PA) antigen and plasminogen activator inhibitor (PAI)-1 antigen were followed in twelve patients treated with direct PTCA for AMI. Before PTCA, only TAT concentrations were significantly elevated compared to normal controls. D-dimer, TAT, PAP and PAI-1 concentrations were similar before and after PTCA. Eleven patients had no recurrent ischaemia and no restenosis on follow-up coronary angiography. These data confirm that direct PTCA is less likely than thrombolysis to affect coagulation and fibrinolysis.

Highly enhanced fucosylation of alpha-fetoprotein in patients with germ cell tumor

BACKGROUND

We have recently reported that simultaneous determination of the fucosylation and glucosaminylation of alpha-fetoprotein (AFP) was useful in the differential diagnosis of various liver diseases. Here, we measured these indices in germ cell tumor and compared them with those in various diseases to reveal the characteristic feature of the carbohydrate moiety of AFP in this tumor.

METHODS

Fucosylation and glucosaminylation indices of AFP were determined for 743 serum samples from 10 patients with germ cell tumor, 437 with hepatocellular carcinoma (HCC), 241 with benign liver diseases (24 patients with acute viral hepatitis, 99 with chronic hepatitis, and 118 with hepatic cirrhosis), and 55 with carcinoma metastatic to the liver from digestive organs (41 from stomach, 10 from gallbladder, 2 from pancreas, and 2 from colon) by crossed immunoaffinoelectrophesis in the presence of concanavalin A and Lens culinaris agglutinin.

RESULTS

The fucosylation index of AFP in germ cell tumors (99% +/- 2%, mean +/- SD) was higher than those in HCC (39% +/- 31%), carcinoma metastatic to the liver (76% +/- 27%), and benign liver diseases (4% +/- 7%); the differences were statistically significant (P < 0.001). The glucosaminylation index of AFP in germ cell tumor (45% +/- 20%) also was significantly higher than those in HCC (4% +/- 4%) and in benign liver diseases (1% +/- 4%) (P < 0.001). The difference in mean percentage of the glucosaminylation index, however, was not significant between germ cell tumors (45% +/- 20%) and carcinoma metastatic to the liver (39% +/- 23%).

CONCLUSIONS

The current study indicates that the most characteristic feature of glycosylation of AFP in germ cell tumors is fucosylation rather than glucosaminylation.

Successful treatment of a patient with idiopathic factor VIII inhibitor with double filtration plasmapheresis and steroid administration

We report a 74-year-old Japanese woman who had bleeding due to a factor VIII inhibitor in the absence of diseases known to be associated with its development. She abruptly developed a large painful purpura extending from the right hip to the thigh followed by an intramuscular haematoma of her left anterior chest. Examinations revealed a marked depression of factor VIII activity (5%) and the presence of 31 Bethesda units/ml factor VIII inhibiting activity. The phenotypes of these inhibitors were of the IgG-kappa and IgG-lambda types. She was treated with oral prednisolone and double filtration plasmapheresis (DFPP). The inhibitors rapidly disappeared after three sessions of plasmapheresis and her plasma factor VIII activity increased to a normal level. During this treatment, no major adverse effects such as thrombosis and infection were observed and transfusion of fresh frozen plasma (FFP) was not necessary. Heterogeneity of idiopathic factor VIII inhibitors in elderly patients is common and spontaneous disappearance or elimination of such inhibitors by treatment is often difficult to achieve. However, the combination of oral prednisolone and double filtration plasmapheresis is effective and safe for idiopathic factor VIII inhibitors and is a worthwhile approach to treatment.

Structural analysis on the sugar chains of human alpha 1-antitrypsin: presence of fucosylated biantennary glycan in hepatocellular carcinoma

Chemical structures of the sugar chains of alpha 1-antitrypsin (AAT) from patients with hepatocellular carcinoma (HCC) and from healthy individuals with a different affinity for Lens culinaris agglutinin (LCA) were examined by pyridylamination of their oligosaccharides and stepwise exoglycosidase digestion in combination with reversed-phase and size-fractionation high-performance liquid chromatography. We found that the LCA-reactive species of AAT from patients with HCC carried both the biantennary sugar chain with a fucose residue at the innermost N-acetylglucosamine residue, Gal beta 1-4GlcNAc beta 1-2Man alpha 1-6(Gal beta 1-4GlcNAc beta 1-2Man alpha 1-3)Man beta 1-4GlcNAc beta 1-4(Fuc alpha 1-6)GlcNAc-PA, and the biantennary chain without a fucose residue, Gal beta 1-4GlcNAc beta 1-2Man alpha 1-6(Gal beta 1-4GlcNAc beta 1-2Man alpha 1-3)Man beta 1-4GlcNAc beta 1-4GlcNAc-PA, at a ratio of about 1:0.6. The LCA-nonreactive species of AAT contained the biantennary sugar chain Gal beta 1-4GlcNAc beta 1-2Man alpha 1-6(Gal beta 1-4GlcNAc beta 1-2Man alpha 1-3)Man beta 1-4GlcNAc beta 1-4GlcNAc as a major component. These results indicate that a characteristic feature of the carbohydrate chains of AAT from patients with HCC is an increment in fucosylation.