Genetic linkage analyses of Romano-Ward syndrome (RWS) in 13 Japanese families

Romano-Ward syndrome (RWS) is an autosomal dominant disorder characterized by prolongation of the electrocardiographic QT interval, with clinical manifestations that include recurrent syncope and sudden death from ventricular arrhythmias. Presymptomatic diagnosis is difficult because of the variability in these signs among carriers, but it is important for clinical management to prevent sudden cardiac death. To find an LQT (long QT) locus in Japanese patients and to identify DNA markers useful for presymptomatic diagnosis, linkage analyses were undertaken in 13 Japanese families with RWS patients by means of two DNA markers located on 11p15.5. One of these marker loci, HRAS, was previously reported to be tightly linked to the LQT locus in another ethnic group. Our analyses of homogeneity suggest evidence for genetic heterogeneity of RWS within the Japanese population.

MR imaging of the uterus: findings from high-resolution multisection dynamic imaging with a surface coil

MR imaging of the female pelvis with a local coil (multiple phased array coils) has been reported. With this method, the signal-to-noise ratio (S/N) is improved so that high-resolution images can be obtained. Dynamic contrast-enhanced MR imaging has been reported to be useful in diagnosing uterine neoplasms. However, dynamic MR imaging is done in only limited imaging planes. When multisection dynamic MR imaging with fast gradient-echo sequences is combined with the use of a local coil, high-resolution images can be obtained throughout the entire uterus during a single breath-hold. This pictorial essay illustrates the appearance of the normal uterus and malignant uterine neoplasms on high-resolution multisection dynamic MR images obtained with a Helmholtz-type surface coil.

Molecular cloning of a gene under control of the circadian clock and light in the rodent SCN

We recently found a mouse unusual per repeat genomic gene showing circadian expression in the suprachiasmatic nucleus (SCN) of rat brain. As an initial step to the better understanding of biological functions of mammalian per repeat family, we isolated a new cDNA clone that encodes for the putative open reading frame of 133 amino acids, designating as mp41, having a per repeat sequence of (ACAGC)32 which lacks one base pair from a mouse unusual per repeat sequence (ACAGGC)n. In situ hybridization showed that the mRNA of mp41 gene expression is detected in the rat pancreas, uterus, ovary, liver, adrenal glands, kidney, intestine, spleen and brain. In brain, daily fluctuations of mp41 mRNA levels were found in the SCN under light and dark cycles--high during the day time and lower during the night time, even in constant darkness for 15 days. After exposing rats to light, mp41 mRNA increased only during the subjective night of the circadian cycle when light also induced the c-fos mRNA expression in the SCN. These results suggest that the transcriptional control of mp41 gene is regulated by light and a circadian clock and indicate that mp41 is a new marker gene for a cycling transcript in the SCN.

Novel N-terminal sequence of a glycine-rich protein in the aleurone layer of soybean seeds

Glycine-rich protein (GRP), a cell wall protein, was extracted with hot water from the aleurone layer of soybean seeds. GRP was purified by adsorption on DEAE-Sephadex, Sephadex G-100 gel chromatography, and anion exchange HPLC. The estimated molecular size of GRP was approximately 30 kDa and GRP contained 59% glycine and 15% serine. The N-terminal amino acid sequence was a novel Gly-Gly-Gly-Gly-Gly-Gly-Gly-Gly-Gly-Gly-Gly-Gly-Gly-Gly-Gly-.

[Blood flow pattern in pulmonary atelectasis with color Doppler flow imaging]

Blood flow pattern in the lesion was evaluated in 4 patients with pulmonary atelectasis by color Doppler flow imaging synchronized electrocardiography. The pulsatile signal and triphasic signal were detected, whereas the continuous signal was not. It seemed that in pulmonary atelectasis the pulsatile signal was the blood flow signal in the pulmonary artery and the triphasic signal was the blood flow signal in the pulmonary vein.

[A case of glycogen storage disease with normal acid maltase accompanied with the abnormal platelet function]

Glycogen storage disease with normal acid maltase first reported by Danon et al. was characterized clinically by mental retardation, cardiomyopathy, and proximal myopathy. Since the first report, 17 patients have been reported including 5 patients from Japan. In this paper we described a 26-year-old man who had dilatated cardiomyopathy with a pacemaker implanted at age 22 years. He was admitted to our hospital complaining of easy fatigability in February 1992. Neurological findings showed that he had mental retardation. Serum CK, GOT, GPT and aldolase levels were elevated. Histopathological study of biopsied skeletal muscle showed intracytoplasmic vacuoles with increased acid phosphatase and slightly increased PAS positive material. Electron microscopic study revealed numerous glycogenosomes (autophagic vacuoles containing glycogen). These pathological findings were similar to acid maltase deficiency, but activities of carbohydrate metabolic enzyme including acid maltase activity were normal in the biopsied muscle. From these results, he was diagnosed as having glycogen storage disease with normal acid maltase. We also found abnormal platelet function and glycogen accumulation in the platelets, which have not been previously described. The disease is probably a systemic disorder affecting not only skeletal and cardiac muscles, but platelets.

[A case of dementia associated with multiple iron deposits in the brain on MRI]

We report a 63-year-old man presenting with dementia and cerebellar ataxia associated with multiple iron deposits in the brain on MRI. Numerous small lesions of low-intensity on both T1- and T2-weighted images were found in the parenchyma and surface of the cerebrum, cerebellum and brain stem. The number and size of lesions were increased on MRI with the method of gradient recalled acquisition in the steady state (GRASS), indicating that they were composed of iron. The similar lesions were not found in any organs on the abdominal GRASS-MRI. Any abnormalities were also not found in the cerebral angiography. Meanwhile, the protein and IgG levels and activated CD4-cells were increased in the cerebrospinal fluid, indicating the involvement of chronic inflammation in the iron deposits in this case.

[Ophthalmological aspects of systemic vasculitis]

Ocular findings of systemic vasculitis, such as polyarteritis nodosa, giant cell angitis, and aortitis syndrome were reviewed. Systemic lupus erythematosus is not categorized as systemic vasculitis, however its ocular findings are microangiopathic. Therefore review of its ocular findings was included in this paper. The most common fundus finding in these diseases is ischemic optic neuropathy or retinal vascular occlusions. Therefore several points in diagnosis or pathogenesis of optic neuropathy and retinal and choroidal vaso occlusion were discussed. Choroidal ischemia has come to be able to diagnosed clinically, since fluorescein angiography was applied in these lesions. When choroidal arteries are occluded, overlying retinal pigment epithelium is damaged. This causes disruption of barrier function of the epithelium and allows fluid from choroidal vasculatures to pass into subsensory retinal spaces. This is a pathogenesis of serous detachment of the retina. The retinal arterial occlusion formed non-perfused retina. Such hypoxic retina released angiogenetic factors which stimulate retinal and iris neovascularizations and iris neovascularization may cause neovascular glaucoma.

Observation of idiopathic full-thickness macular holes. Follow-up observation

OBJECTIVES

To evaluate the long-term follow-up observation of idiopathic full-thickness macular holes, with emphasis on the incidence and process of disappearance.

METHODS

The authors followed up 97 eyes with idiopathic full-thickness macular holes for a period ranging from 2 to 182 months (average, 66 months).

RESULTS

Apparent disappearance of the hole was observed in six eyes. Although improvement in visual acuity of at least 2 lines resulted in all six eyes, visual acuity improved to 20/30 or better in those eyes in which macular holes disappeared within 24 months of the initial examination.

CONCLUSION

The incidence of apparent disappearance of idiopathic full-thickness macular holes was low. Improvement in visual acuity was greater in those cases in which macular holes disappeared in a relatively short period of time.

Cultured mouse keratinocyte allografts prime for accelerated second set rejection and enhanced cytotoxic lymphocyte response

It has been reported that cultured keratinocyte (CK) allografts are not rejected in mice, unlike in other species. Several reports have suggested that mouse CK allografts are incapable of stimulating a primary alloresponse, including sensitization of recipients to alloantigens. In this study, we investigated the immunogenicity of mouse CK allografts in vivo by determining whether CK allografts primed for a second set rejection response. First, we grafted mice with either CK allografts, CK autografts, full-thickness (FT) allografts, or no graft at all. We then regrafted mice 4 weeks later with a tail skin allograft. Mice grafted with CK allografts rejected second allografts as rapidly and as vigorously as mice grafted with FT flank allografts. Next, we tested whether CK allograft primed recipients for enhanced CTL responses. We found that mice grafted with CK allografts generated a significantly enhanced CTL alloreactive response after in vitro stimulation. The response was similar to that of mice grafted with FT skin allografts. With evidence that CK allografts primed, we biopsied wounds immediately after CK allografting and, using Western immunoblotting, found that CK allografts had substantial expression of MHC class II antigens in vivo. We conclude from the results of our studies that mouse CK allografts unequivocally prime recipients to alloantigens in vivo and suggest that a possible mechanism for alloantigen priming may be CK allograft expression of MHC class II antigens.

In vitro mutation analysis of Arabidopsis thaliana small GTP-binding proteins and detection of GAP-like activities in plant cells

Previously, we have reported the molecular cloning of ara genes encoding a small GTP-binding protein from Arabidopsis thaliana. The criterion based on amino acid sequences suggest that such an ara gene family can be classified to be of the YPT/rab type. To examine the biochemical properties of ARA proteins, several deletions and point mutations were introduced into ara cDNAs. Mutant proteins were expressed in E. coli as GST-chimeric molecules and analyzed in terms of their GTP-binding or GTP-hydrolysing ability in vitro. The results indicate that four conserved amino acid sequence regions of ARA proteins are necessary for GTP-binding. A point mutation of Asn at position 72 for ARA-2, or 71 for ARA-4, to Ile decreased GTP-binding and a point mutation of Gln at position 126 for ARA-2, or 125 for ARA-4, to Leu suppressed GTP-hydrolysis activity. Furthermore, certain factors associated with the membrane fraction accelerated GTPase activities of ARA proteins, suggesting the presence of GTPase activating protein(s) (GAP(s)) in the vesicular transport system of higher plant cells.

Clonal expansion and persistence of human T cells specific for an immunodominant myelin basic protein peptide

TCR rearrangements were used to probe the clonal origin of myelin basic protein (MBP)-reactive T cells from patients with multiple sclerosis (n = 7) and normal subjects (n = 3). The majority of MBP-specific T cell lines were specific for the immunodominant MBP(84-102) and MBP(143-168) peptides and were restricted by HLA-DR molecules. In two patients with the DR2 haplotype, the T cell response to MBP was focused on the MBP(84-102) peptide. In both patients, in vivo expanded population(s) (three expanded populations in the first patient, one expanded population in the second patient) dominated the response to the MBP(84-102) peptide. Two MBP(84-102)-specific T cell clones from a normal subject with the DR2 haplotype were also found to have identical TCR sequences. Clonality was proven by demonstrating that independent clones had identical TCR alpha- and TCR beta-chain sequences as well as identical sequences of a TCR gamma-chain or of a second TCR alpha-chain rearrangement. Repeated analysis of one patient after 13 mo demonstrated that the three expanded clones had persisted in vivo. A representative of one of the expanded clones was again obtained after 31 mo by IL-2 stimulation suggesting that this clone was activated in vivo. These data suggest that the response to human MBP is dominated in at least some subjects by expanded clones that may persist in vivo for relatively long periods of time.

Studies on rat hepatic hydroxysteroid sulfotransferase--immunochemistry, development and pI variants

Rat hepatic hydroxysteroid sulfotransferase with sulfoconjugates androsterone (androsterone-sulfating sulfotransferase) is an oligomer consisting of several subunits with distinct pI values but with the same molecular mass (pI variants). N-terminal amino acid sequences of the pI variants are all identical. The enzyme is exclusively present in the liver, in which its lobular localization is sex-dependent. The localization of the enzyme is markedly different from that of an isoenzyme of phenol sulfotransferase. In weanling and adult female rats, the relative abundance of the pI variants is different. During development from weanling stage to adulthood, the amounts of acidic variants increase, whereas the relative levels of alkaline variants remain constant.

Clonal expansion and persistence of human T cells specific for an immunodominant myelin basic protein peptide

TCR rearrangements were used to probe the clonal origin of myelin basic protein (MBP)-reactive T cells from patients with multiple sclerosis (n = 7) and normal subjects (n = 3). The majority of MBP-specific T cell lines were specific for the immunodominant MBP(84-102) and MBP(143-168) peptides and were restricted by HLA-DR molecules. In two patients with the DR2 haplotype, the T cell response to MBP was focused on the MBP(84-102) peptide. In both patients, in vivo expanded population(s) (three expanded populations in the first patient, one expanded population in the second patient) dominated the response to the MBP(84-102) peptide. Two MBP(84-102)-specific T cell clones from a normal subject with the DR2 haplotype were also found to have identical TCR sequences. Clonality was proven by demonstrating that independent clones had identical TCR alpha- and TCR beta-chain sequences as well as identical sequences of a TCR gamma-chain or of a second TCR alpha-chain rearrangement. Repeated analysis of one patient after 13 mo demonstrated that the three expanded clones had persisted in vivo. A representative of one of the expanded clones was again obtained after 31 mo by IL-2 stimulation suggesting that this clone was activated in vivo. These data suggest that the response to human MBP is dominated in at least some subjects by expanded clones that may persist in vivo for relatively long periods of time.

Prognostication of nontraumatic avascular necrosis of the femoral head. Significance of location and size of the necrotic lesion

After reviewing the radiographs of 149 hips with nontraumatic avascular necrosis of the femoral head (ANFH), a method for evaluating the prognosis in patients with ANFH in its early stages was devised. The evaluation was made primarily by classifying the radiographic features of each involved femoral head according to the location and size of its necrotic lesion. In a group of 120 hips, massive collapse occurred without exception in cases where both of the following criteria were true. First, in a standing position, the necrotic lesion involved more than the medial one third of the weight-bearing surface from the anteroposterior view. Second, from the lateral view, the lesion occupied more than 43% of the total area of the femoral head. However, in 29 hips, the extent and size of necrosis was less than the above, and no massive collapse occurred during the follow-up period of three to 15 years (average, 5.2 years). In these 29 hips, function was preserved. These data suggest that hips with a high risk for collapse can be reliably selected during the early stages of ANFH.

[Intracordal injection therapy using atelocollagen for unilateral laryngeal paralysis under local anesthesia]

Intracordal injection therapy is a surgical therapeutic modality for glottic incompetence caused by unilateral laryngeal paralysis. Atelocollagen, which has recently been attracting attention as a material for use in intracordal injection therapy that supplants silicon, was initially claimed and expected, by virtue of its salient biophysical properties, not to cause impaired wave-motion of the vocal mucosa when injected into the submucosa. Unfortunately, however, our attempt to use this material for the same purpose proved disappointingly unsuccessful, with vocal sounds produced thereafter being metallic, vocal folds becoming tense and consequently transforming the site into a muscular coat of vocal muscles. During the past 3 years, we at the Department of Otolaryngology of the Jikei University School of Medicine, have performed intracordal injection therapy with atelocollagen on 20 patients diagnosed as having unilateral laryngeal paralysis under local anesthesia using a flexible fiberscope and a stroboscope under a video monitoring system. Comparisons were made of the voice before and after injection in 6 patients receiving submucosal injection and 14 given intramuscular injection of the material. In some autopsied patients, histological findings of the treated vocal cords were scrutinized and problems regarding atelocollagen injection were investigated. Judging from pathological findings of the vocal cords after atelocollagen injection and the clinical results of this therapeutic procedure, it seems most appropriate to inject this plastic material into the vocal muscles. This will prevent atelocollagen diffusion and maintain unimpaired wave-motion of the vocal mucosa, thus resulting in an acceptable voice quality.

[Migrating radiculopathy--an unusual complication of systemic lupus erythematosus in an HTLV-1 carrier]

We reported a 54-year-old HTLV-I seropositive female patient with systemic lupus erythematosus (SLE), who developed migrating radiculopathy but without chronic progressive myelopathy. She occasionally noticed butterfly rash and photosensitivity of the skin as well as painful episodes in different joints for 10 years. She developed pins and needles sensation on her trunk a few days after she experienced lumbago with abrupt onset. Neurological examinations revealed normal muscular strength, exaggerated deep tendon reflexes without Babinski signs, and dysesthesia on her upper extremities and the trunk. The latter symptom showed a segmental distribution of spinal nerve roots. And during the course of the disease, it migrated in accord with a radicular pattern. This sensory disturbance was fairly responsive to corticosteroid treatment. The spinal tap yielded clear cerebrospinal fluid (CSF) which showed mononuclear pleocytosis (16/mm3) with predominance of CD8+ cytotoxic cells and a positive result for anti-HTLV-I antibody. A neurological status deteriorated in parallel with non-neurological symptoms as SLE, when the patient had discontinued corticosteroids in a tapering course by herself. We postulate that HTLV-I infection in this patient modulated original autoimmune reactions as SLE, which led to manifestation of migrating radiculopathy possibly due to autoimmunity against ganglion cells. This is, to our knowledge, the first report of migrating radiculopathy in an SLE patient associated with HTLV-I infection.

Mouse thioredoxin gene maps on chromosome 4, whereas its pseudogene maps on chromosome 1

Thioredoxins are involved in various biochemical systems and mediate both redox and nonredox functions. In mammalian cells, thioredoxin functions as an endogenous glucocorticoid receptor activating factor and as an adult T-cell leukemia-derived factor (ADF) that stimulates expression of interleukin-2 receptor in human T-cell leukemia virus (HTLV)-I transformed T cells. We have mapped the thioredoxin gene (Txn) and its processed pseudogene (Txn-ps1) in the mouse using a panel of interspecific backcross mice. Txn maps to Chr 4, whereas Txn-ps1 maps to the proximal region of Chr 1.

Mutation of the alpha 2 domain disulfide bridge of the class I molecule HLA-A*0201. Effect on maturation and peptide presentation

A combination of saturation and site-directed mutagenesis was utilized to disrupt the alpha 2 domain disulfide bridge of HLA-A*0201. Mutation of cysteine 101 to a serine (C101S) or of cysteine 164 to alanine (C164A) decreased the rate of maturation of the heavy chain, the total amount of mature heavy chain within the cell, and the level of surface expression. Cells expressing these genes and loaded with a synthetic peptide derived from the influenza A matrix protein (58-66) were recognized poorly by HLA-A*0201-restricted, peptide-specific CTLs. Cells expressing mutant HLA-A*0201 loaded with a synthetic peptide derived from the HIV-1 pol protein (476-484) were not recognized by pol IV-9-specific CTLs. Mutant C164A cells infected with influenza virus were partially recognized by influenza matrix peptide-specific CTLs, while C101S cells were not lysed. Surprisingly, endogenous peptide loading of cells expressing mutant HLA-A*0201 using a minigene coding for either the influenza A matrix peptide 58-66, or HIV-1 pol peptide 476-484, resulted in efficient CTL recognition. This suggests different structural constraints for peptide binding in the endoplasmic reticulum during biosynthesis and for binding to exported molecules on the cells surface.

Limited visual search on the WAIS Picture Completion test in patients with schizophrenia

The Wechsler Adult Intelligence Scale was examined in 39 patients with schizophrenia, the visual cognitive task of Picture Completion showing the most impairment. In order to clarify the role of eye movements in Picture Completion, searching eye movements in 12 schizophrenic patients and 12 normal controls were recorded using an infrared eye-mark recorder. Schizophrenic patients as a group showed fewer eye fixations, and shorter total length of scan path than normal controls during the last 10 s of exposure to the picture. However, the patients who responded correctly, did so with a similar number of fixations and similar length of total scan path to those of normal controls. The patients who failed in the task took a significantly longer time for the first survey of the picture than the successful patients and normal controls. The less efficient strategy of visual search seen in the patients who failed might be a manifestation of poor reality testing and be related to frontal lobe dysfunction.

Transfilter bone induction by Chinese hamster ovary (CHO) cells transfected by DNA encoding bone morphogenetic protein-4

This study was undertaken to identify the factor responsible for classical transfilter bone induction by a murine osteosarcoma. Chinese hamster ovary (CHO) cells were transfected with the complementary DNA (cDNA) for bone morphogenetic protein-4 (BMP-4) that was purified from a murine (Dunn) osteosarcoma. Diffusion chambers were filled with the cells expressing the gene for BMP-4 and implanted subcutaneously into the flanks of ICR strain nude mice. Ectopic transfilter bone formation was seen consistently on the outer surfaces of the cellulose acetate membranes of chambers containing transfected cells at three weeks after implantation. Bone was not observed on chambers loaded with nontransfected CHO cells. The transfected CHO cells were inoculated into nude mice to form tumors, which were then homogenized, defatted, and bioassayed also in the ICR, nu/nu mice. The cell-free implants consistently elicited new bone and marrow within three weeks, whereas the control implants consisting of nontransfected tumor were not osteoinductive. These experimental results suggest that BMP-4 is one of the molecules responsible for the transfilter bone induction by vital Dunn osteosarcoma cells reported by Heiple and for the ectopic bone induction after implantation of devitalized, freeze-dried Dunn osteosarcoma tissue described originally by Amitani.