The effect of cyclosporine on mortality and renal function in living related pediatric kidney transplant recipients

The outcome, incidence of acute rejection episodes, complications and cyclosporine (CyA) induced nephrotoxicity were studied in 10 pediatric kidney transplant recipients who were grafted from one-haplotype indentical parent with immunosuppression of CyA and prednisolone (Pred). Excellent patient and graft survival could be achieved in this population with low incidences of acute rejection or serious complications as when compared with the results of azathioprine (AZ) treated pediatric patients. With a mean follow-up of 12.9 months (range 1 to 50 months), the patient survival rate was 100 per cent and the graft survival rate was 100, 84, 84 and 84 per cent at 1, 2, 3 and 4 years post transplantation, respectively. Serum creatinine levels in the group were 0.97, 1.17, 1.14 and 1.2 mg/dl at 3, 6, 12 and 24 months post transplantation, respectively. The incidence of treated acute rejection episodes was 20 per cent (2 out of 10) in the CyA-treated children, whereas it was 53 per cent (9 of 17) in the Az-treated children. Five children who had undergone transplant surgery before they were 11 years old displayed linear growth in height after their transplantation. There have been no opportunistic infections, aseptic necrosis or peptic ulcers in this group and cyclosporine nephrotoxicity has not been a serious problem in the pediatric recipients. Only 10 per cent (1 out of 10) of the recipients displayed acute nephrotoxicity and only one recipient has converted from CyA + Pred to CyA + AZ + Pred (Three drug therapy) due to persistent nephrotoxicity.(ABSTRACT TRUNCATED AT 250 WORDS)

The in vivo immunosuppressive action of suppressor cells from alloantigen-cyclosporine-treated mice and the capacity of spleen cells to release interleukins and gamma-interferon

Antigen-nonspecific suppressor T cells were identified in spleens of mice rendered unresponsive by sensitization of allogeneic antigen in combination with cyclosporine (CsA) treatment. Suppressor cells were obtained from C57BL/6 (B6, H-2b) mice treated with a single i.p. injection of 1 x 10(7) allogeneic P815 (H-2d) cells combined with a five-day course of CsA, a group that did not show any cytotoxic activity of spleen cells against P815 targets. These noncytolytic spleen cells displayed suppressor activity on the induction of cytotoxic T (Tc) cells of normal lymphocytes against not only P815 stimulator (80.9% suppression, P less than 0.01, responder:additional cell ratio = 2.5:1) but also third-party BW5147 (H-2k) stimulator (68.2% suppression, P less than 0.01). The unresponsive state appears to be due to suppressor T (Ts) cells that are nonadherent to plastic or nylon-wool, 1500 rads-sensitive, and Thy-1-positive. Capacities of spleen cells from CsA-P815-treated mice to release cytokines (interleukin 1 [IL-1]), interleukin 2 [IL-2], interleukin 3 [IL-3], and gamma-interferon [gamma-IFN]) were examined. Spleen cells from CsA-P815-treated B6 mice displayed 84.1%, 91.7% and 90.8% inhibition (0.35 +/- 0.07 U/ml, 1.4 +/- 0.29 U/ml, and 7.0 +/- 0.9 U/ml) of IL-1, IL-2, and gamma-IFN production compared with normal mice (2.2 +/- 0.54 U/ml, 16.9 +/- 2.1 U/ml, and 76.0 +/- 3.1 U/ml, P less than 0.01), respectively. However, IL-3 production was significantly less inhibition (46.1%, 2.35 +/- 1.0 U/ml in CsA-P815-treated mice and 4.36 +/- 1.7 U/ml in normal mice) compared with other cytokines (IL-1, IL-2, gamma-IFN). Two systems were employed to assess the immunosuppressive efficacy of antigen-nonspecific Ts cells in vivo. First, adoptive transfer (i.p.) of spleen cells harvested from CsA-P815-treated mice ten days after treatment on 3 consecutive days (days 0, 1, 2) at a 3 x 10(7) cell dose into virgin B6 mice that were immunized with P815 cells (1 x 10(7), day 0) completely inhibited the development of Tc cells against P815 targets (5% specific cytolysis, effector:target ratio [E:T] = 200). The suppressor effect was immunologically nonspecific; adoptive transfer of Ts cells from CsA-P815-treated mice also abrogated the development of Tc cells against third=party BW5147 cells.(ABSTRACT TRUNCATED AT 400 WORDS)

Results of kidney transplantation in 25 pediatric patients

Outcome, long-term prognosis, growth activity and rehabilitation after kidney transplantation were studied in 25 pediatric patients transplanted with a kidney graft from one-haplotype identical parent. Excellent patient and graft survival with low incidences of acute rejection or serious complications could be achieved in this population, as compared with the results of adult recipients. Growth retardations in height and weight were observed in these patients before transplantation, and were significantly correlated with the duration of low or no kidney function. In 12 recipients who were transplanted at ages of younger than 15 years and followed up over two years, a dramatic increase in weight appeared within one year after transplantation and a greater increase in height was exhibited in the second and third year than in the first. Increase in height was significantly greater in those children transplanted at ages of younger than 10 years than in those transplanted at ages of older than 11 years. Catch-up growth was observed in one-third of these children. Retrospectively, there was no difference in the doses of prednisolone given between the two groups of patients with, and without catch-up growth, but the incidence of acute rejection was higher in the group without catch-up growth. Currently, 18 recipients have functioning grafts and 16 (88.9 per cent) of them are in full-time school or working. From these results it is concluded that kidney transplantation is the first feasible manoeuvre for those children with chronic renal failure and it should be performed as soon an possible in order to preserve their growth activity.

Effect of cadmium on vitamin D-non-stimulated intestinal calcium absorption in rats

The present report demonstrates the effect of Cd on intestinal Ca transport and Ca-binding protein in rats adapted to vitamin D repletion and high Ca. There were significant decreases in in vitro intestinal Ca transport in animals exposed to Cd for 2 or 3 months as compared with controls. Ca transport from everted gut sacs of normal rats showed a dose-dependent decrease. 45Ca-binding activity to intestinal mucosa from Cd-exposed rats showed a lower level of decrease than that on control rat mucosa. The typical peak of Cd-binding protein obtained from Sephadex G-100 gel filtration of 109Cd added to mucosal supernatant agreed with results of gel filtration obtained after 45Ca had been added to the same supernatant. Although there were 2 proteins binding Cd or Ca in the intestinal mucosa, with the same molecular weight of 10,000, these proteins were shown to be different, since Cd did not bind with the Ca protein. It was concluded that inhibition of vitamin-D-non-stimulated Ca transport was not caused by Cd bound to Ca-binding protein, but by some other factor.

Influence of cadmium on the metabolism of vitamin D3 in rats

In order to obtain further information on the effects of cadmium (Cd) on the mechanism of activation of vitamin D3 in the kidney, the serum concentrations of 1,25-dihydroxycholecalciferol [1,25(OH)2D3] and 24,25-dihydroxycholecalciferol [24,25(OH)2D3] were determined by radioimmunoassay techniques. The serum concentration of 1,25(OH)2D3 in Cd-exposed rats was always higher than that in control rats. The concentrations of serum 1,25(OH)2D3 in parathyroidectomized rats (PTX), both in the control and in the Cd-exposed groups, were markedly lower than those in non-PTX rats. On the other hand, the concentration of serum 24,25(OH)2D3 in Cd-exposed rats was less than that in control rats. In other words, the pathway from secretion of parathyroid hormone (PTH) to synthesis of 1,25(OH)2D3 or 24,25(OH)2D3 was normal, but the pathway from stimulation of PTH to secretion of PTH was abnormal. These results suggest that rats exposed to Cd for 90 days were in a state of either deficiency of 1,25(OH)2D3 or excess secretion of parathyroid hormone. Although hypophosphatemia occurred in the Cd-exposed rats, the 1,25(OH)2D3 serum level in rats was not increased by PTX. On the basis of these results, it is suggested that hypophosphatemia occurring after the exposure of rats to Cd is a secondary hypophosphatemia.

[Pharmacokinetics in neonates and infants following administration of amikacin]

Sixteen neonates (at ages of 8 to 28 days) and 8 infants (at ages of 35 days to 1 year), who were in need of treatment with amikacin sulfate, were subjected to the present study. The drug was administered by intramuscular route (1.39 to 3.13 mg/kg) or by intravenous drip infusion over a 30 to 60 minutes period (2.94 to 6.00 mg/kg). Blood levels and urinary excretion of the drug were investigated with these subjects. The blood levels were also analyzed according to pharmacokinetic models. 1. When the drug was administered intramuscularly to neonates at average doses of 1.49 and 2.96 mg/kg and to infants at average doses of 2.97 mg/kg peak levels of 2.74, 6.53 and 8.55 micrograms/ml, respectively, were attained at 30 minutes after dosing. 2. When the drug was administered to neonates at average doses of 3.01 and 5.89 mg/kg by intravenous drip infusion over a 30 to 60 minutes period and to infants at average doses of 2.97 and 6.00 mg/kg in the same manner, peak levels of 7.70, 20.9, 9.40 and 23.0 micrograms/ml, respectively, were attained at the end of the intravenous drip infusion. 3. Urinary levels and recovery rates tended to increase with ages of these subjects. Urinary recovery rates for the neonates and the infants were 41.0 and 58.9%, respectively, on the average. 4. From a pharmacokinetic analysis of blood levels of the drug, it was concluded that, in any of the subjects who received the drug intramuscularly or by intravenous drip infusion, it would be possible to use the one-compartment open model. In the subjects who received the drug by intravenous drip infusion, however, it was determined the two-compartment open model would be the choice. 5. In the neonates and the infants, whose blood levels were analyzed according to the one-compartment open model, Ka values averaged 7.51 and 6.62 hr-1, respectively, with respective average Kel values of 0.32 and 0.66 hr-1. Average Vd values obtained were 0.36 and 0.26 L/kg, respectively. There was a negative correlation between the Vd values and the ages of the subjects, while there was a positive correlation between the Kel values and the ages. 6. Appropriate conditions for administering the drug by intravenous drip infusion to neonates and infants at ages of more than 1 week were investigated taking observed blood levels and achieved peak levels and trough levels calculated using the one-compartment open model into account.(ABSTRACT TRUNCATED AT 400 WORDS)

A rapid assay method for ammonia using glutamine synthetase from glutamate-producing bacteria

A rapid enzymatic assay method for ammonia was developed by using glutamine synthetase from glutamate-producing bacteria together with pyruvate kinase, lactate dehydrogenase, and NADH. The time required for determination of 25 nmol of ammonia was 5 min with 1 unit of glutamine synthetase, as opposed to 14-30 min with 1 unit of glutamate dehydrogenases from various sources. The present method was used to determine ammonia in serum, microbiol-culture broth, and waste water. The method can be modified for spectrophotometry in the visible region by substituting pyruvate oxidase, peroxidase, and appropriate chromogens for lactate dehydrogenase and NADH. With 4-aminoantipyrine (4AA) and phenol, and with 4AA and N-ethyl-N-2-hydroxyethyl-m-toluidine as chromogens, the sensitivity of ammonia determination was 0.65 and 1.7 times that with glutamate dehydrogenase, respectively. The present method was also applicable to the continuous detection of the activity of some ammonia-forming enzymes such as guanase, adenosine deaminase, and urease and to the determination of 0.5-30 microM ATP-ADP after some modification of the mixture.

[Efficacy of vagotomy on liver regeneration in the prevention of stress ulcer after partial hepatectomy in the cirrhotic rat]

Possible effects of vagotomy (a means of preventing stress ulcers after partial hepatectomy in cirrhotic liver) on liver regeneration were explored. Cirrhosis was induced in rats by means of intraperitoneally administering 4% thioacetamide for 10 consecutive weeks. These rats were subjected to partial hepatectomy (ca. 68% resection) and vagotomy at the same time. Normal rats of consistent age served as controls after receiving hepatectomy. In controls, which received hepatectomy alone, both gastric pH and gastric wall blood flow showed a significant reduction on the third day after surgery. In animals which received both hepatectomy and vagotomy, postoperative reduction in gastric pH was suppressed, but postoperative reduction in gastric wall blood flow was more marked compared to those of controls. In animals which received both hepatectomy and vagotomy, postoperative 3H-thymidine intake and thymidine kinase activity were markedly suppressed compared to controls. In animals which received both hepatectomy and vagotomy, the peak level of mitotic index and the hepatic regeneration rate were markedly suppressed compared to those of controls. The above results indicate that vagotomy is not advantageous to liver regeneration and prevention of stress ulcer after partial hepatectomy in cirrhotic rat because of its potency of inducing marked reduction in gastric wall blood flow and impediment of liver regeneration.

Interaction of lymphocytes with hepatocytes containing hepatitis B antigen: ultrastructural demonstration of target antigen and T-cell subsets by the peroxidase antibody technique

Hepatitis B virus associated antigens and subsets of lymphocytes in liver tissue were studied using immune electron microscopy to clarify the immune mechanism of hepatocyte lysis in type B chronic hepatitis. Using conventional electron microscopy, infiltrating lymphocytes were observed in direct contact with hepatocytes in areas of piecemeal necrosis and focal necrosis; they showed various types of surface adherence with a contact gap of approximately 20 nm in width. The majority of the hepatocytes that were in contact with lymphocytes could be shown to contain HBsAg and/or HBcAg by immune electron microscopy: HBsAg was localized in the endoplasmic reticulum membranes, in tubular structures, and on the outer coat of Dane particles; HBcAg was observed in the nuclei and in the cytoplasmic matrix of hepatocytes. In some cases HBsAg was observed on the plasma membrane of hepatocyte in contact with lymphocytes. Immune electron microscopy using monoclonal antibodies to subsets of human T-lymphocytes revealed that the lymphocytes in areas of piecemeal necrosis and focal necrosis were predominantly CD 5 or CD 8 positive. In contrast, CD 4 positive cells were infrequently observed in necro-inflammatory regions and Leu 7 positive cells were randomly scattered in the sinusoids away from areas of hepatocyte necrosis. These data suggest that HBsAg is at least one of the target antigens expressed on the hepatocyte membrane possibly enabling cytolytic interaction by cytotoxic T cells in chronic type B hepatitis.

Heparin binding affinity of rat prostatic growth factor in normal and cancerous prostates: partial purification and characterization of rat prostatic growth factor in the Dunning tumor

The rat prostate contains two types of growth factors capable of stimulating DNA synthesis in BALB/3T3 cells. These rat prostatic growth factors (RPGF) were separable by a different affinity for heparin: low affinity type RPGF and high affinity (HiA) type RPGF. About 80% of the RPGF in the cytosol from normal prostates was low affinity type, whereas more than 80% in the cytosol from the Dunning tumors was HiA type. Elution profile of HiA-RPGF showed two peaks of activity eluted from the heparin-Sepharose column, one at 1.3-1.4 M NaCl (HiA1-RPGF) and the other at 1.6-1.7 M NaCl (HiA2-RPGF). HiA2-RPGF could be purified 1100-fold from the Dunning tumor (AT-3 subline) in about 20% recovery by heparin-Sepharose chromatography. The partially purified HiA2-RPGF in the Dunning tumor has a molecular weight of about 19,000 and isoelectric point of about 3.8, and stimulated DNA synthesis at a concentration of about 0.25 nM. The activity was lost by heat treatment at 70 degrees C for 5 min and by acid treatment, whereas it was stimulated by incubating with dithiothreitol. The HiA2-RPGF did not have transforming growth factor activity at a concentration of 250 ng/ml or lower in the presence of epidermal growth factor.

Effect of combined H-1 and H-2 histamine receptor antagonists on late asthmatic response in an asthmatic patient

A curious inhibitory effect of histamine H-1 and H-2 antagonists on isolated late asthmatic response (LAR) in an asthmatic patient was observed. When given alone, neither the H-1 nor the H-2 antagonist had an effect on LAR. The combination of drugs, however, provided marked inhibition of LAR. These findings suggest that histamine contributes to some types of LAR.

Isolation of a 41 kilodalton cytosol protein from the Dunning rat prostatic adenocarcinoma: characterization as depolymerized actin isomers

Except for albumin, a 41,000-dalton protein (41K) in the cytosol of the Dunning R-3327 rat prostatic adenocarcinoma was found to be the most abundant soluble protein. This protein was purified in nearly homogeneous state by conventional chromatographies. After the first chromatography, because of the adhesive nature of the protein, 0.5% SDS and 2 M urea were necessary for subsequent steps of purification. The amino acid composition of the purified 41K was similar to that of actin isolated from rabbit skeletal muscle. Alternatively, 41K could be extracted from the Dunning tumor in the presence of ATP and dithiothreitol, under conditions in which actin molecules are depolymerized, and could be purified by the same method as cytoskeletal actin. The purified protein showed properties similar to rat skeletal muscle actin in amino acid composition and antigenicity. Both 41K proteins were found to be composed of four components having different isoelectric points. These results indicate that most actin exists in a depolymerized form as a cytosol protein of 41,000 daltons in the Dunning tumor and is composed of at least four isomers.

[Experimental study on efficacy of cimetidine and 16,16-dm PGE2 to liver regeneration in prevention of stress ulcer after partial hepatectomy in the cirrhotic rat]

Stress ulcer is a common phenomenon after hepatectomy for cirrhotic liver. We examined experimentally the influence of cimetidine and 16,16-dm PGE2 dosaged as counter-measures against stress ulcer on liver regeneration after partial hepatectomy for cirrhotic liver. Using cimetidine and 16,16-dm PGE2, there was a noticeable suppression of the onset of water immersion stress ulcer, and both a decline in the blood flow in the wall of the stomach and a drop in PH in the stomach were inhibited after partial hepatectomy for cirrhotic liver. The group given 16,16-dm PGE2 after partial hepatectomy had a higher rate of DNA synthesis as compared with the group which had only partial hepatectomy. No difference was seen between the group given cimetidine and the only partial hepatectomy groups. The group given indomethacin before partial hepatectomy for cirrhotic liver had a noticeable decrease in mitotic index 30 hours after partial hepatectomy. However, the group given both indomethacin and 16,16-dm pGE2, showed some recovery of the mitotic index.