Involvement of the c-kit receptor in the adhesion of hematopoietic stem cells to stromal cells

The proto-oncogene c-kit, encoding a receptor-type tyrosine kinase, is allelic with the W locus of the mouse. The stromal cell line OP9, capable of supporting long-term hematopoiesis, was newly established from a newborn B6C3F1-op/op mouse calvaria. When bone marrow cells of WBB6F1-W/Wv mice were cocultured with the OP9 cells in liquid medium, hematopoiesis declined to a level one-thousandth of that in the cocultures of bone marrow cells of WBB6F1-+/+ mice and stromal cells by day 21. In contrast, when bone marrow cells of W/Wv mice were cocultured with OP9 cells in semisolid medium, at least 61% of the number of colonies were detected until the end of our observation period of 42 days when compared with that in control cocultures, although colonies formed by hematopoietic stem cells of W/Wv mice were significantly smaller than those of normal stem cells. After a 24-hour incubation with OP9 cells, fewer stem cells of W/Wv mice than normal ones adhered to the stromal cells. Adhesion of normal stem cells to stromal cells was inhibited by the addition of an antagonists anti-c-kit monoclonal antibody, ACK2. These results demonstrate that the c-kit receptor plays an important role not only in the proliferative response of hematopoietic stem cells but also in their adhesion to stromal cells.

Generation of lymphohematopoietic cells from embryonic stem cells in culture

An efficient system was developed that induced the differentiation of embryonic stem (ES) cells into blood cells of erythroid, myeloid, and B cell lineages by coculture with the stromal cell line OP9. This cell line does not express functional macrophage colony-stimulating factor (M-CSF). The presence of M-CSF had inhibitory effects on the differentiation of ES cells to blood cells other than macrophages. Embryoid body formation or addition of exogenous growth factors was not required, and differentiation was highly reproducible even after the selection of ES cells with the antibiotic G418. Combined with the ability to genetically manipulate ES cells, this system will facilitate the study of molecular mechanisms involved in development and differentiation of hematopoietic cells.

Enhancement of gastric mucosal blood flow by beta-3 adrenergic agonists prevents indomethacin-induced antral ulcer in the rat

Indomethacin (32 mg/kg s.c.) produced mainly antral ulcers in refed rats but almost exclusively corpus erosions in fasted rats. Subcutaneous doses of a nonselective beta (isoproterenol), a selective beta-2 (salbutamol) and selective beta-3 adrenergic agonists CBRL35135, (R*,R*)-(+/-)-methyl 4-[2-[2-hydroxy-2-(3-chlorophenyl)ethylamino]propyl] phenoxyacetate hydrobromide; CL316,243, disodium (R,R)-5-[2-[[2-(3-chlorophenyl)-2-hydroxy-ethyl]- amino]propyl]-1,3-benzodioxole-2,2-dicarboxylate; SR58611A, ethyl[(7S)-7-[(2R)-(2(3-chlorophenyl)-2-hydroxyethylamino]5,6,7, 8-tetrahydronaphthalen-2-yloxy]acetate hydrochloride) dose-dependently attenuated the antral ulcers, and their activities were in the order of BRL35135 (ED50 = 0.03 mg/kg) > CL316,243 (ED50 = 0.04 mg/kg) > SR58611A (ED50 = 0.2 mg/kg) > isoproterenol (ED50 = 0.4 mg/kg) > salbutamol (ED50 = 6 mg/kg). Whereas only isoproterenol, salbutamol and BRL35135 significantly attenuated the corpus erosions and reduced gastric acid secretion in pylorus-ligated rats. In in vitro, all the beta agonists enhanced the beating rate of guinea pig atria (beta-1 action) and inhibited spontaneous contractions of rat uterus (beta-2 action) and colon (beta-3 action). There was found a statistically significant correlation between the IC50 values of the drugs on the colon and ED50 values on the indomethacin-induced antral ulcers (r = 0.97). In addition, the beta agonists excepting salbutamol increased antral gastric mucosal blood flow in rats anesthetized with halothane, and the activities were arranged in the potency order of inhibiting colon motility.(ABSTRACT TRUNCATED AT 250 WORDS)

Characteristics of partially purified prolidase and prolinase from the human prostate

Both prolidase and prolinase from the human prostate were separated into two peaks by TSK DEAE-5PW chromatography. These peaks of prolidase isozymes I and II differed from each other in their responses to preincubation with Mn2+, their substrate specificity, optimal pH, and heat stability. The molecular weights of prolidases I and II were estimated to be 110,000 and 165,000, respectively, by gel filtration. Substrate specificity of prolinase peaks I and II was almost the same, but they differed in optimal pH and heat stability. The molecular weights of prolinases I and II were about 85,000 and 63,000, respectively. These results indicate that two isozymes of prolidase and of prolinase, which differ in various characteristics, are present in the human prostate.

Development of hyperglycaemia and insulin resistance in conscious genetically diabetic (C57BL/KsJ-db/db) mice

A bolus injection of insulin dose-dependently reduced plasma glucose levels in genetically diabetic (db/db) mice and their normoglycaemic litter-mates (+/+ mice) aged 5, 8 and 12 weeks. Compared between the groups, the dose-response curves showed that insulin resistance was already present in the 5-week-old db/db mice when they were still normoglycaemic. The minimum effective dose of insulin was lower in the +/+ (32 micrograms/kg) than in the db/db (100 micrograms/kg) mice and the maximum response which was obtained at 320-1000 micrograms/kg of the hormone was higher in the former (about 80%) than in the latter (about 55%). Although the basal plasma glucose levels in the db/db mice were significantly increased with age as compared with those in the +/+ mice, the insulin response curves were identical in the db/db mice from 5 to 12 weeks of age. The number of insulin binding sites were significantly decreased by 22-50% (5-12-week-old) in the liver plasma membrane from the db/db mice compared with that from the +/+ mice, while its affinity was not significantly changed between the groups. Streptozotocin (100 mg/kg, i.p.) treatment increased the number of insulin receptors in the db/db mice to a number comparable with those in the +/+ mice. Coinciding with the change, the hypoglycaemic action of insulin was slightly enhanced in the streptozotocin-treated db/db mice compared with that in non-treated db/db mice, but was still considerably depressed when compared with that in +/+ mice.(ABSTRACT TRUNCATED AT 250 WORDS)

N-terminal amino acid sequence of a 28 kDa major serum high density lipoprotein of the rainbow trout Oncorhynchus mykiss

As there are few data on primary structures of fish apolipoproteins (apo), we determined the N-terminal sequence of a 28 kDa major serum protein of rainbow trout, a possible homologue of apoAI protein in higher vertebrates. Rainbow trout serum was separated by two-dimensional electrophoresis. A spot of the 28 kDa protein (pl 5.45) was cut out and directly applied to a protein sequencer. We succeeded in sequencing 30 amino acids from the N-terminal. The sequence of the 28 kDa protein shared a high similarity with that of apoAI of Atlantic salmon (Salmo salar). These results showed that the 28 kDa protein is apoAI of rainbow trout.

Isolation and characterization of rainbow trout (Oncorhynchus mykiss) serum amyloid P component (SAP)

We purified a Ca(2+)-dependent agarose-binding protein from rainbow trout (Oncorhynchus mykiss) sera. SDS-PAGE analysis showed the possibility that the purified protein was a polymer with a molecular weight of over 100,000 composed of covalently-bounded 32-kDa subunits. N-terminal twenty amino acid sequence of the 32-kDa protein showed partial homology with other known serum amyloid P components (SAPs) including plaice (Pleuronectes platessa) (indicated 40% homology), human (55%), hamster (45%), rat and mouse (40%) SAPs. In electron micrographs the 32-kDa protein was observed as pentameric disc-like structure. On the basis of the results, the 32-kDa agarose-binding protein of rainbow trout was concluded to belong to pentraxin family and to be a SAP homologue.

Adhesion of NFS-60 myeloid leukemia cells to MC3T3-G2/PA6 stromal cells induces granulocyte colony-stimulating factor production

To examine the interaction between immature myeloid cells and stromal cells in the induction of granulocyte colony-stimulating factor (G-CSF) production, stromal cells of the MC3T3-G2/PA6 (PA6) murine cell line, which has preadipocyte characteristics and can support hematopoiesis, were cocultured with various myeloid cell lines and G-CSF mRNA expression was examined by Northern and reverse transcriptase-polymerase chain reaction analyses. A significant amount of G-CSF mRNA was induced by the culture of an interleukin-3/G-CSF-dependent murine myeloid leukemia cell line, NFS-60, on PA6 stromal cells for 16 hours. Using a G-CSF-dependent subline of DA-1 (DA-1N), the biologic activity of G-CSF was also detected in PA6/NFS-60 coculture supernatants, but not in the culture supernatant of PA6 or NFS-60 alone. Direct contact of NFS-60 cells with the PA6 stromal layer was essential for the induction of G-CSF mRNA, as indicated by the following observations: (1) NFS-60 cells efficiently adhered to PA6 cells; (2) medium conditioned by NFS-60 cells did not contain the activity to induce G-CSF mRNA in PA6 cells; and (3) induction of G-CSF mRNA was not observed when NFS-60 cells were separated from PA6 cells by a microporous membrane (0.45-microns pore size). Several other myeloid cell lines, including FDC-P2, 32Dcl3, WEHI-3, and DA-1, did not induce G-CSF mRNA expression after the coculture with PA6 cells, although significant numbers of these cells adhered to PA6 cells. Therefore, NFS-60 cells may express or overexpress a molecule that is involved in adhesion-mediated induction of G-CSF production.

Liquid chromatographic-mass spectrometric analysis of N-acetylamino acids in human urine

Liquid chromatography-atmospheric pressure chemical-ionization mass spectrometry (LC-APCI-MS) was used for the analysis of N-acetylamino acids that could not be determined with an amino acid analyzer. LC-APCI-MS could directly detect the protonated molecular ions of various synthetic N-acetylamino acids, distinguishing N-acetylserine from O-acetylserine and N(alpha)-acetyllysine from N(epsilon)- acetyllysine. Furthermore, N-acetylasparagine, N-acetylaspartic acid, N-acetylglutamine and N-acetylglutamic acid were identified in normal human urine. The assay data for N-acetylaspartic acid agree with a previous report using gas chromatography-mass spectrometry. These results demonstrate the usefulness of the apparatus described above for the analysis of N-acetylamino acids in biological samples.

Expression of a heterodimeric (placental-intestinal) hybrid alkaline phosphatase in KB cells

A hybrid heterodimeric alkaline phosphatase expressed in KB cells, consisting of placental and intestinal (fetal) subunits, was purified by use of two different immunoaffinity columns using the monoclonal antibodies 2HIMS-1 and HPMS-1. The closely related subunits were found to yield a dimeric active enzyme glycosylated as the mature heterodimeric forms. This enzyme displays intermediate properties to the placental and intestinal (fetal) isozymes with regard to heat stability, inhibition patterns with amino acids and amino acid derivatives, as well as reactivity with monoclonal antibodies specific for human alkaline phosphatase isozymes. Peptide fragments obtained from the hybrid enzyme after cyanogen bromide cleavage belong to either the placental or intestinal (meconial) isozyme as evaluated by SDS polyacrylamid gel electrophoresis, and the N-terminal amino acid sequences, corresponding to the placental and intestinal subunits, can be identified in the peptide fragments. By N-glycanase digestion or tunicamycin treatment, the molecular mass of the subunits was reduced to 62 kDa compared to 69 kDa for the native ones. The results confirm that some cell lines can synthesize hybrid alkaline phosphatases.

[Thoracotomy for patients with bronchial asthma]

We discussed the perioperative management in three patients with bronchial asthma who underwent thoracotomy. The management was as follows: 1. theophylline and steroid agents were preoperatively given till wheezing disappeared, 2. just before surgery, theophylline or beta-stimulator and steroid agents were given, 3. during surgery, aminophylline and steroid agents were given and bronchodilative anesthetics were inhaled, 4. steroid agents were postoperatively applied sufficiently so that signs due to bronchial asthma don't appear. Preoperative respiratory conditions improved with disappearance or decrease of wheezing, and resection of giant bulla and lobectomies with radical mediastinal lymph node dissection were safely possible with no evidence of the side effects due to steroid administration. The perioperative sufficient suppression of airway-tract hyperactivity is very important for thoracotomy in patients with bronchial asthma.

Expression of Mac-2 antigen in the preosteoclast and osteoclast identified in the op/op mouse injected with macrophage colony-stimulating factor

Osteoclast deficiency in op/op mice is cured by a single injection of 5 micrograms recombinant human macrophage colony-stimulating factor (rhM-CSF). In this study, we found that mouse osteoclasts are positive for Mac-2 antigen, but not for F4/80, MOMA-2, Mac-1, or BM8 antigen. By using F4/80 and MOMA-2 monoclonal antibodies, we confirmed the absence of mature macrophages in the femora of op/op mice and found that multiple injections of rhM-CSF are required for the recruitment of macrophages in the bones. After a single rhM-CSF injection, we found Mac-2 positive mononuclear cells in the femora of op/op mice. The time course of the appearance of Mac-2-positive cells was very similar to that of tartrate-resistant acid phosphatase (TRAP)-positive cells. In bone sections prepared from the mutant mice that received rhM-CSF 3 days earlier, 91% of the TRAP-positive mononuclear cells were also positive for Mac-2 antigen. These results demonstrate the expression of Mac-2 antigen in preosteoclasts. The antigen was detected on the plasma membrane of preosteoclasts, as well as in their cytoplasm and nucleus, and in the extracellular matrix in the space between the cells and bone. Since Mac-2 is a galactose-specific lectin, a potential role of the lectin in cell-cell and cell-matrix adhesion during osteoclast differentiation is suggested.

[Clinical results of breast conservation therapy; a radiotherapeutical viewpoint]

Between November 1987 and March 1993, 244 breasts in 243 patients underwent breast conserving therapy at Kyoto University Hospital. Clinically, there were 159 stage I and 85 stage II tumors. Pathological staging showed 216 stage I, 24 stage II, and 4 stage III tumors. All except 10 tumors were invasive ductal carcinomas. Eleven tumors were margin--positive by histopathological examinations. As surgical treatment, quadrantectomy or wide excision with complete axillary dissection was performed. Radiation therapy consisted of 50 Gy delivered to the whole breast by opposed tangential fields over 5 weeks using 60Co gamma rays. For patients with a positive margin, boost electron irradiation was given to a total of 10 Gy. We used the CT simulator for individualized optimization of the tangential fields. Prompt and accurate determination of the tangential portals was possible by using the simulator to determine various parameters, including beam angle and the head rotation angle. During follow-up for 2-66 months (median, 20 months), unrelated death occurred in 2 patients and distant metastases developed in 5 patients (bone 4, lung 1). However, neither local recurrence nor symptomatic radiation pneumonitis has occurred. The cumulative survival rate and the disease--free survival rate at five years were 95.2% and 91.8%, respectively. These promising clinical results of breast conservation therapy encourage further clinical trials.

Genetic Enhancement of Cold Tolerance by Expression of a Gene for Chloroplast [omega]-3 Fatty Acid Desaturase in Transgenic Tobacco

The increased production of trienoic fatty acids, hexadecatrienoic (16:3) and linolenic (18:3) acids, is a response connected with cold acclimation of higher plants and is thought to protect plant cells against cold damage. Transgenic tobacco (Nicotiana tabacum cv SR1) plants that contain increased levels of 16:3 and 18:3 fatty acids, and correspondingly decreased levels of their precursors, hexadecadienoic and linoleic acids, were engineered by introduction of a chloroplast [omega]-3 fatty acid desaturase gene (the fad7 gene) isolated from Arabidopsis thaliana. When exposed to 1[deg]C for 7 d and then cultured at 25[deg]C, the suppression of leaf growth observed in the wild-type plants was significantly alleviated in the transgenic plants with the fad7 gene. The low-temperature- induced chlorosis was also much reduced in the plants transformed with the fad7 gene. These results indicate that increased levels of trienoic fatty acids in genetically engineered plants enhance cold tolerance.

Stromal cell-dependent bone marrow culture with a nearly protein-free defined medium

We examined the ability of a defined medium mSFO2 to support stromal cell-dependent B lymphopoiesis and myelopoiesis. Both ST2 and PA6 stromal cell lines were able to form monolayers in the presence of mSFO2 alone. While the ST2 monolayer could last for long period of time, either bFGF or EGF were required for the maintenance of the PA6 monolayer with mSFO2. mSFO2 did support the generation of distinct stages of B precursors on the ST2 layer and this culture condition was efficient enough to be used for limiting dilution assay of in vitro clonable B progenitors. While ST2 cell line failed to support long-term myelopoiesis with mSFO2, PA6 in combination of bFGF was able to support sustained generation of various hematopoietic progenitors. Indeed, 20 times increase of IL-3 reactive colony-forming cells was induced upon culturing the normal bone marrow cells on the PA6 layer for 8 days with mSFO2. Because total protein concentration of mSFO2 is only 10 micrograms/ml consisting of transferrin and insulin, the present result that mSFO2 is able to support the proliferation of normal hematopoietic progenitor cells would make an important step towards the standardization of bone marrow culture.

[The treatments of manic-depressive psychosis]

There are a number of types of treatment for manic-depressive psychosis, including pharmacotherapy, psychotherapy, electroconvulsive therapy and continuous sleep treatment. The most generally used therapy for mania is pharmacotherapy, including the use of lithium and major tranquilizers. With regard to depression, the choice of treatment from among pharmacotherapy, psychotherapy and physiotherapy must be made on a case by case basis. In some cases, we have chosen electroconvulsive therapy, continuous sleep treatment or other forms of therapy. On admission, it is difficult to obtain the patient's consent for treatment, when he lacks insight about his condition. In this paper, we describe the choice of treatments, requirements for admission, and management of the structure of treatment.

Non-invasive ultrasonic urination sensor for ambulatory patient support

It is estimated that, in Japan, several million people suffer from urinary incontinence caused by, e.g., cerebrovascular disease, abdominal operations, spinal-cord damage, etc. Urinary incontinence is said to be a 'hidden' disease. When no adequate treatment is given, a serious situation may arise for both patients and their family. A non-invasive and unconstrained ultrasonic sensor has been designed enabling patients to discretely manage urination. The major problem of the sensor is how to maintain a proper irradiation angle to obtain an anteroposterior bladder diameter which corresponds to the actual bladder volume. Many types of ultrasonic probe holders have been tested and promising results have been obtained. The most practical, but as yet experimental, method is a four-element ultrasonic sensor, embedded in a flat probe.

Measurement of iminodipeptides in the serum of patients with prolidase deficiency using liquid chromatography-mass spectrometry

Iminodipeptides containing C-terminal proline or hydroxyproline were determined in sera from patients with prolidase deficiency, in their mother's serum, and in the sera of unrelated controls, using liquid chromatography-mass spectrometry with an atmospheric pressure ionization interface system. The separation was carried out on a reversed phase column using 1 g/l aqueous trifluoroacetic acid-methanol (75 + 25, by vol.). The quasi-molecular ions ([M + H])+ of various iminodipeptides containing C-terminal proline and hydroxyproline were observed in the sera of patients with prolidase deficiency, using selected ion monitoring. The quasi-molecular ions ([M + H])+ of iminodipeptides containing C-terminal proline were not observed in the sera of normal subjects or the patients' mother, but the latter did contain various iminodipeptides with C-terminal hydroxyproline. This method proved useful for the determination of iminodipeptides in the sera of patients with prolidase deficiency.

[Effect of lithium, carbamazepine, and setiptiline on diacylglycerol in rat brain ex vivo]

The effect of lithium on diacylglycerol (DAG), which is an intracellular second messenger, was compared with those of carbamazepine and setiptiline ex vivo through phosphatidylinositol turnover (PI response). Consequently, (1) PI response cycling by stimulation of norepinephrine participated in the alpha 1 receptor. (2) DAG accumulation in rat brain exhibited a biphasic pattern. (3) Lithium elevated DAG accumulation at 30 seconds after stimulation by norepinephrine. (4) Carbamazepine did not affect DAG accumulation. (5) Setiptiline decreased DAG accumulation at 30 minutes after stimulation by norepinephrine.

Effect of chlamydial antibodies on the outcome of in vitro fertilization (IVF) treatment

OBJECTIVE

Our objective was to study the relationship between the presence of Chlamydia trachomatis antibodies and the success of IVF treatment.

DESIGN

We evaluated 118 in vitro fertilization and embryo transfer (IVF-ET) treatment cycles from 51 couples with a history of infertility lasting for at least 2 years. All women starting a treatment cycle had their serum chlamydial antibody titers measured by indirect immunofluorescent technique. All patients received similar ovarian stimulation regimens and the oocytes collected were inseminated with similar concentrations of motile sperm. Clinical data from couples where the female partner had C. trachomatis ab titers > or = 40 have been compared with the equivalent data from couples where the female partner had C. trachomatis ab titers < 40.

RESULTS

There was no statistically significant difference between the two groups concerning age, infertility period, oocytes collected, oocytes fertilized, and fertilization rate, and the pregnancy rates were comparable.

CONCLUSION

Previous exposure to C. trachomatis did not alter the success rate of IVF-ET.

Bone metastasis as a prognostic factor in breast cancer patients with liver metastasis given OK-432-combined adoptive immunotherapy via the hepatic artery

The outcome in 31 patients with liver metastases from breast cancer given OK-432-combined adoptive immunotherapy via the hepatic artery was analyzed. Patients received intraarterial OK-432, a streptococcal preparation, followed by the transfer of autologous lymphocytes cultured with autologous tumor extract and interleukin-2 for 9-13 days. Liver lesions were evaluable in 11 of the 12 patients with bone metastasis (group A) and in 16 of the 19 patients without bone metastasis (group B). Complete response (CR) in the liver was attained in 8 patients in group A, but in only 1 in group B (p < 0.01). In group A, radiological features of all metastatic foci of bone improved after CR in the liver. Moreover, the median survival time (MST) of group A (20 months) was longer (p = 0.06) than that of group B patients with extra-hepatic metastasis (n = 12; MST = 6 months), while group B patients with liver metastasis alone (n = 7) showed a MST similar to that of group A. Thus, loco-regional immunotherapy via the hepatic artery was found to be useful in controlling both liver and bone metastasis from breast cancer. Moreover, in breast cancer patients with liver metastasis, bone metastasis appears to be a prognostic factor associated with good response to this immunotherapy.

ADP-ribosylation of rainbow trout (Oncorhynchus mykiss) actin by botulinum C2 toxin

Intracellular actin of rainbow trout macrophages was ADP-ribosylated by botulinum C2 toxin, which is composed of two nonlinked protein components, component I and trypsinized component II. The actin in the supernatants of various tissue homogenates of the trout was also directly ADP-ribosylated by component I of C2 toxin, indicating that fish actin other than those of land vertebrates is susceptible to enzymatic modification by component I of C2 toxin.

Pentoxifylline-enhanced acrosome reaction correlates with fertilization in vitro

To evaluate the possible effect of pentoxifylline on the acrosome reaction (AR) and its correlation with in-vitro fertilization (IVF), sperm samples obtained from 51 patients who underwent IVF treatment were studied. Acrosome reactions were evaluated as spontaneous, pentoxifylline-treated and calcium ionophore (A23187) induced, before and after treatment. The correlation of AR with fertilization in vitro in spermatozoa pre-treated with pentoxifylline was sought. In cases with failure or very low fertilization rate (< or = 10%) in their previous trials, spermatozoa after swim-up were treated before insemination. Spontaneous acrosome loss remained low even after treatment (mean +/- SD: 8.18 +/- 1.74%). Response to A23187 was enhanced significantly (P < 0.001) by pre-treatment with pentoxifylline in 33 control cases (group A) in which fertilization in vitro was previously successful without this treatment. Patients with at least two episodes of failed fertilization were divided into two groups. In 11 cases (group B), the IVF rate was improved significantly (P < 0.001) by the treatment. This was not observed in seven cases (group C) in which the treatment induced no increase in IVF rate. We achieved nine (27.3%) pregnancies in group A and five (45.4%) pregnancies in group B. This study demonstrated that pentoxifylline enhanced A23187 induced the acrosome reaction and this effect was correlated with improvement in IVF rate.

[Methylmalonic acidemia with bilateral MRI high intensities of the globus pallidus]

We report a patient with methylmalonic acidemia who developed an acute extrapyramidal disorder after severe ketoacidosis. The neurologic findings resulted from bilateral destruction of the globus pallidus. A 10-year-old girl was the term product of an uncomplicated pregnancy and delivery. Poor feeding and vomiting were noted after one month. She was hospitalized at 6 months of age with vomiting, coma and tachypnea. Analysis of urinary organic acids revealed a massive amount methylmalonic acid. She was not vitamin B 12-responsive and was maintained on a low-protein diet. At 33 months of age, she was able to walk and speak, but she developed acute severe ketoacidosis. Involuntary movements and spastic paraplegia became evident two days after admission. Subsequently, the patient has had metabolic ketoacidosis once or twice a year. Her intelligence quotient was 47. Neurologic examination revealed spastic paraplegia and generalized hypotonicity with mild dystonia. Some relief from dystonic symptoms has been obtained through the use of L-dopa. A brain CT scan at 5 years of age disclosed bilaterally symmetric lucencies of the globus pallidus. T2-weighted brain MRI at 8 years of age showed bilateral symmetric high intensities of the globus pallidus.