Changes in the phosphorylation states of connexin43 in myoepithelial cells of lactating rat mammary glands

Using specific antibodies and cDNA probe, we examined the expression pattern of a major gap junction protein, connexin43 (Cx43), in rat mammary glands during pregnancy and lactation. Double immuno-fluorescence revealed that the labeling of Cx43 was superimposed in the alpha-smooth muscle actin-positive cells, suggesting that myoepithelial cell were interconnected by gap junctions formed of Cx43. Just after delivery, the Cx43-labeled plaques were enlarged and increased in intensity. Northern and Western blot analyses confirmed the dramatic induction of Cx43 at both mRNA and protein levels on the day of parturition. Cx43 mRNA transcript immediately declined, while the increase of Cx43 protein continued for a few days. During pregnancy, immunoblots showed two bands of almost equal amounts at 43 and 45 kDa. Following delivery, the 45-kDa band gradually increased in intensity with a concomitant decrease of the 43-kDa band. From the sixth day of lactation, Cx43 was always detected as a single band at 45 kDa. Alkaline phosphatase treatment of immunoprecipitated Cx43 revealed that both bands represented phosphorylated forms, thus indicating that Cx43 was naturally phosphorylated and that it altered its phosphorylation states during lactation stages. These results suggest that the induction of Cx43 with the changes in the phosphorylation states plays an important role in the lactating function of myoepithelial cells in rat mammary glands. This is the first report on the changes of Cx43 phosphorylation states during physiological stages in vivo.

Sarcocystis mihoensis n. sp. from sheep in Japan

Sarcocystis mihoensis n. sp., a heteroxenous coccidium was detected from sheep in Japan and dogs were experimentally determined as the definitive host. The cysts were 1,300-2,100 x 200-300 microns in size and had the thick cyst wall which was 10 to 12 microns thick and provided with radial striated and finger-like villar protrusions. Two 6-month old dogs fed with the cysts passed sporocysts, 15-16 x 8-9 microns in size, in the feces from day 11 to days 57-60 after ingestion. No domestic cats fed with same cysts shed sporocysts throughout the experimental period.

Dynamics of connexins, E-cadherin and alpha-catenin on cell membranes during gap junction formation

We examined the dynamics of connexins, E-cadherin and alpha-catenin during gap-junction disassembly and assembly in regeneration hepatocytes by immunofluorescence microscopy, and immunogold-electron microscopy using SDS-digested freeze-replicas. The present findings suggest that during the disappearance of gap junctions most of the gap junction plaques are broken up into smaller aggregates, and then the gap junction proteins may be removed from the cell membrane, but some of the connexons or connexins remain dispersed in the plane of membrane as pure morphologically indistinguishable intramembrane proteins. Double-immunogold electron microscopy using a polyclonal antibody for connexins and a monoclonal antibody for E-cadherin or alpha-catenin revealed co-localization of these molecules at cell-to-cell contact sites during the reappearance of gap junction plaques. This implies that, at least in regenerating hepatocytes, the cadherin-catenin complex-mediated cell-to-cell contact sites act as foci for gap junction formation. In addition, connexin-immunoreactivity was also observed along tight junctional strands, suggesting that the gap junction may also form along the tight junctions.

Changes of lipoxygenase and fatty acid hydroperoxide lyase activities in bell pepper fruits during maturation

Developmental changes in fatty acid hydroperoxide lyase (HPO lyase) and lipoxygenase (LOX) during the maturation of bell pepper fruits (Capsicum annuum L. cv. Kyonami) were examined by means of activity measurements, immunological detection of both the enzymes, and analysis of the volatile compounds formed upon homogenization of the fruits. Both the enzyme activities decreased with maturation, and immunological studies showed that the amounts of the enzymes concomitantly decreased. The amounts of six-carbon aldehydes and alcohols formed from bell pepper fruits upon homogenization also decreased during maturation, and with the fully ripened red fruits, these volatile compounds were hardly detectable. These results suggest that the major factor contributing to the changes in the composition of volatile compounds during the maturation of bell pepper fruits was changes in the amounts of HPO lyase and LOX.

Elevated levels of type II soluble tumor necrosis factor receptors in the bronchoalveolar lavage fluids of patients with sarcoidosis

Since tumor necrosis factor (TNF) is known to be involved in granuloma formation in sarcoidosis, and soluble TNF receptors (sTNF-Rs) inhibit TNF action in vivo, we evaluated the levels of sTNF-Rs in the bronchoalveolar lavage fluids (BALF) of 31 subjects using an enzyme-linked immunosorbent assay. Our group consisted of 13 patients with sarcoidosis (7 sarcoidosis patients who received no treatment and 6 who received corticosteroid therapy) and 18 control subjects (11 healthy nonsmokers and 7 asymptomatic smokers). Type II (75-kDa), but not type I (55 kDa) sTNF-R in BALF was elevated significantly in patients with sarcoidosis compared with the healthy nonsmokers (type I: 126.7 +/- 17.6 pg/ml BALF vs 79.4 +/- 16.5 pg/ml BALF, p > 0.05; type II: 98.3 +/- 27.8 pg/ml BALF vs 26.7 +/- 4.9 pg/ml BALF, p < 0.05). Although levels of type I sTNF-R in BALF from sarcoidosis patients were not correlated with any cellular profiles of BALF, concentrations of type II correlated significantly with the numbers of lymphocytes in BALF. We concluded that sTNF-R is a normal constituent of the epithelial lining fluids and that levels of type II sTNF-R are elevated significantly in the BALF from individuals with sarcoidosis. This suggests that sTNF-Rs may influence the local bioactivity of TNF and may also contribute to the pathogenesis of sarcoidosis.

Cerebral ischemic disorders and cerebral oxygen balance during cardiopulmonary bypass surgery: preoperative evaluation using magnetic resonance imaging and angiography

We compared the preoperative prevalence of small cerebral infarctions and carotid stenosis to jugular venous oxygen saturation (Sjvo2) during coronary artery bypass grafting (CABG). Sjvo2 served as an indicator of whether cerebral oxygen supply meets demand in patients on cardiopulmonary bypass (CPB). The study population consisted of 121 patients who were either older than 65 yr or had a history of cerebrovascular disease. The patients underwent preoperative cerebral magnetic resonance imaging (MRI) and cervical magnetic resonance angiography (MRA) to detect small cerebral infarctions and carotid artery stenosis. Patients with atherosclerosis of the ascending aorta were identified by intraoperative epiaortic ultrasonography. Liberation of emboli from the aorta in these patients was prevented by modification of the standard operation. From preoperative MRI and MRA, 65 patients (54%) had small cerebral infarctions in the white matter or basal ganglia and nine patients (7%) demonstrated moderate or severe stenosis in the carotid arteries. Thirteen patients (11%) had moderate or severe atheromatous disease of the ascending aorta. The severity of aortic atherosclerosis was significantly correlated with the grade of carotid stenosis (P < 0.05). In patients with small infarctions, Sjvo2 was significantly lower than in patients without infarctions (controls) at initiation of CPB, 30 min after aortic cross-clamping, and during the rewarming period of CPB (P < 0.05). Thus, small cerebral infarctions were not uncommon in elderly patients undergoing CABG. Patients with small cerebral infarctions may be at risk for an imbalance in cerebral oxygen supply and demand during the rewarming period because they are unable to deliver the necessary compensatory blood flow.

Selective breeding for high serum IgA levels from noninbred ddY mice: isolation of a strain with an early onset of glomerular IgA deposition

An outbred mouse strain known as ddY has been reported to spontaneously develop, late in life, mesangioproliferative glomerulonephritis with a severe glomerular immunoglobulin A (IgA) deposition that mimics human IgA nephropathy. However, the incidence of the disease in this strain is not very high, probably due to its heterogeneous genetic background. Therefore, we attempted to isolate a strain with a high incidence and an early onset of the disease through selection for high serum IgA from the outbred ddY mice. The selection procedure was successful in increasing the serum IgA level of the selected line and proved effective both in increasing the incidence and in accelerating the onset of the disease. We propose to designate this line of mice 'HIGA', denoting a line with high serum IgA levels. More than half of the mice from the HIGA strain showed a moderate to severe glomerular IgA deposition as early as 25 weeks of age. The severe deposition observed was comparable to that occasionally seen in the original nonselected ddY strain after 40 weeks of age. Thus, we have succeeded in generating a mouse model of IgA nephropathy with a high incidence and an early onset of glomerular IgA deposition. Using light microscopy, progressive and marked mesangial matrix accumulation was shown to develop in HIGA mice. However, they showed only mild proteinuria (100-300 mg/dl) and did not show hematuria.

Immunohistochemical expression of SKALP/elafin in squamous cell carcinoma of the oesophagus

In this study, the immunohistochemical expression of a new inducible elastase inhibitor, SKALP (skin-derived anti-leucoproteinase)/elafin, in the tissue of squamous cell carcinoma and uninvolved oesophageal mucosa was studied using a polyclonal rabbit anti-serum against SKALP/elafin. The results were compared with the immunohistochemical staining of proliferating cell nuclear antigen (PCNA) and the TUNEL assay in serial sections. In non-malignant oesophageal mucosa, the expression of SKALP/elafin was localized in the cells of the stratified zone overlying the PCNA-positive basal zone. In oesophageal cancer, the incidence of the expression was significantly related to the degree of the differentiation of the tumour. Characteristically, the expression was almost limited in tumour cell nests that had a clear squamous phenotype. In tumour cell nests, the expression of SKALP/elafin was localized in the cells overlying PCNA-expressing cells and no expression was found in the cells that expressed PCNA; DNA fragmentation was often observed in the same cell layers as those in which SKALP/elafin immunoreactivity was found. This enzyme inhibitor is speculated to be involved in the induction of the cell differentiation and apoptosis of human squamous cell carcinoma cells of the oesophagus.

Mitral regurgitation caused by mitral paraannular cyst

A case of mitral regurgitation (MR) caused by mitral paraannular cyst is reported. A 37-year-old woman on maintenance hemodialysis was admitted to Akita University Hospital because of congestive heart failure. Echocardiography revealed mitral paraannular cyst, which caused coaptation failure of the mitral leaflets and significant MR. She underwent decapsulation of the cyst followed by mitral valve replacement. Postoperative echocardiography showed no recurrence of the cyst three years after surgery. Although mitral annular calcification has been described as a cause of MR in patients with uremia, a report of a solitary intracardiac cyst which causes significant MR is quite rare.

Expression and localization of annexin V and annexin VI during limb bud formation in the rat fetus

We have investigated the expression and the localization of annexin V and annexin VI during the development of rat fetal limb buds by immunoblot and immunocytochemical analysis. Neither annexin V nor annexin VI was detectable in undifferentiated mesenchymal cells in limb buds of the day-13-day-16 rat fetus. Skeletal muscles, whose progenitor cells migrate from the somites and appeared in the limb buds at day 14, dramatically expressed annexin VI on the cell surface after differentiation from mononucleated myogenic cells into multinucleated myotubes. At day 16 both annexin V and annexin VI were found to be expressed in differentiated chondrocytes as well as in the perichondrium, a precursor of chondrocytes, whereas the compact layer of mesenchymal cells surrounding a chondrification center (precartilage) did not show any immunoreactivity for either of these proteins. The results suggest a close relationship between the expression of these annexins and cell differentiation of chondrocytes and skeletal muscles during limb but development.

Immunohistochemical findings of arterial fibrinoid necrosis in major and lingual minor salivary glands of primary Sjögren's syndrome

Arterial fibrinoid lesions in major salivary glands and lingual minor salivary glands from four autopsied patients with primary Sjögren's syndrome were studied histologically and immunohistochemically. On a morphological basis, the preceding arterial fibrinoid necrosis was regarded as medial damage, particularly of smooth muscle cells. The medial smooth muscle cells underwent vacuolated degeneration and disappeared, and resulted in full-blown fibrinoid arteritis. By means of the immunoperoxidase method the distribution of the immunoglobulins, fibrin, complement (C3), transferrin, ferritin, vimentin and lysozyme was studied. The normal arterial wall reacted with the lambda light chain of immunoglobulin, transferrin and vimentin Vacuolated degeneration of medial smooth muscle cells, regarded as the initial change in cases of vascular fibrinoid lesion, was positive for IgG, C3 and vimentin. We suggest that IgG antibody is a useful marker to detect the initial phase of arterial fibrinoid necrosis. In the foci of fibrinoid necrosis, fibrin, C3 and vimentin were detected. Among these three antibodies, only fibrin was negative in the normal arterial wall and vacuolated degenerates of medial smooth muscle cells. Mononuclear cells surrounding areas of fibrinoid necrosis stained strongly with antisera to immunoglobulins, transferrin, ferritin and vimentin, and negatively with fibrin, C3 and lysozyme antibodies.

Isolation and preliminary characterization of the Streptococcus mutans rpsJ gene

We previously reported that four putative open reading frames were identified in the regions flanking the Streptococcus mutans GS-5 fructosyltransferase gene. For one of these, ORF 4, only a small region had been isolated and the first 30 nucleotides had been sequenced. In order to determine whether this open reading frame is part of an expressed gene, we isolated a DNA fragment containing intact ORF 4 and a portion of the downstream ORF 5 by inverse polymerase chain reaction. A comparison of the deduced amino acid sequences of ORF 4 and ORF 5 with other proteins revealed that the ORF 4 and ORF 5 gene products were highly homologous to ribosomal proteins S10 and L3, respectively, of several bacteria. To identify the precise transcriptional start site for the ORF 4 gene, primer extension analysis was carried out. The results indicated initiation at a G residue with corresponding -10 and -35 regions homologous to the Escherichia coli consensus promoter sequences. These results indicate that the sequences of ORF 4 and ORF 5 are consistent with the structures of ribosomal proteins S10 and L3, respectively, and are present in a ribosomal protein operon.

Stimulation of interleukin-1beta-independent interleukin-6 production in human dental pulp cells by lipopolysaccharide

Dental pulpal infection is most commonly caused by extensive dental caries. A principal driving force behind pulpal disease response appears to lie in the immune system's response to bacteria. However, the production of interleukin (IL)-1beta and IL-6 in human dental pulp (HDP) cells in response to lipopolysaccharide (LPS) has not been well characterized. We examined IL-1beta and IL-6 production in HDP cells by challenging with LPS from Porphyromonas endodontalis, which is a Gram-negative bacteria found in root canals. Our results presented here showed that when HDP cells were stimulated by LPS, the production of IL-6 always preceded that of IL-1beta. Since the IL-6 production was observed even in the presence of the IL-1beta receptor antagonist, we concluded IL-6 production was independent of the IL-1beta molecule in LPS-stimulated HDP cells. This idea was further supported by the results obtained from RT-PCR experiments, in which IL-6 mRNA, but not IL-1beta mRNA, was present in the RNA preparation isolated from the early stage of cells.

Content and characteristics of vitamin B12 in some seaweeds

The vitamin B12 (B12) content in seven species of seaweed that are consumed frequently in Hokkaido, Japan, was microbiologically measured using Escherichia coli 215. Asakusanori (Porphyra tenera), maruba-amanori (Porphyra suborbiculata) and akaba-gin-nansou (rhodo-glossum pulcherum) showed higher B12 content than the other species, although the content varied greatly among samples in the same species. A bioautography on a thin-layer plate holding a mixture of silica gel and cellulose, differentiation of B12 and its analogues using a binding specificity of intrinsic factor and haptocorrin, and comparison of the B12 concentration determined by the radioisotope dilution assay method using the intrinsic factor as the B12-binding protein with that by the bioassay method, predominantly showed B12 in maruba-amanori and B12 analogues in wakame (Undaria pinnatifida) and akaba-gin-nansou. The B12 uptake of akaba-gin-nansou from artificial seawater was similar to that of asakusanori that contained only B12.

[Successful induction of immune tolerance and novel hemostatic effects in a hemophilia A with high-responder inhibitor by regular infusions of factor VIII]

A hemophilia A patient with high responder inhibitor had been treated by (activated) prothrombin complex concentrates (A) PCC and activated factor VII until the occurrence of intracranial bleeding at the age of 6 years. Since the inhibitor titer was decreased less than 1 Bethesda Units/ml, high dose of factor VIII was given followed by the infusions of factor VIII concentrates (100 units/kg) three times a week. In spite of previous episodes of anamnestic responses by factor VIII products before, the inhibitor titer did not increase and disappeared completely 6 months after the FVIII infusion therapy. The specific anti-factor VIII IgG subclasses of the inhibitor were IgG2 and IgG4. The inhibitor recognized both light and heavy chains. He have no bleeding episode for 6 months since the beginning of the prophylactic with factor VIII concentrates.

Detection of circulating anti-p53 antibodies in patients with colorectal carcinoma and the antibody's relation to clinical factors

PURPOSE

Mutation of the p53 tumor suppressor gene is the most common genetic alternation in colorectal carcinoma and is assessed mainly by molecular analysis of the gene sequence or by immunohistochemical analysis of p53 protein accumulation. Purpose of this study was to detect circulating antibody against p53 proteins in serum of patients with colorectal carcinoma and to evaluate its clinical significance.

METHODS

We used immunoblotting techniques to detect circulating anti-p53 antibodies. Relationship among staging, immunohistochemical expression of p53 in the primary tumor, and serum carcinoembryonic antigen level was investigated.

RESULTS

Circulating anti-p53 antibodies were detected in 32 (68 percent) of 47 patients. Antibody was found in patients at all clinical stages of disease. In 33 patients whose sera and primary tumor tissues were available for testing, 16 (48 percent) were positive for both circulating anti-p53 antibody and p53 expression in the tumor. The anti-p53 antibody test was positive in 78 and 56 percent of patients with high and normal serum carcinoembryonic antigen levels, respectively.

CONCLUSION

Detection of anti-p53 antibodies may become a new diagnostic indicator of colorectal carcinomas.

Expression of heat shock protein 70 (HSP70) and EBV latent membrane protein 1 (LMP1) in Reed-Sternberg cells of Hodgkin's disease

Tissue sections embedded in paraffin and fixed in formalin from 65 patients with Hodgkin's disease (HD) were examined for the presence of heat shock protein 70 (HSP70) and Epstein-Barr virus (EBV)-encoded latent membrane protein 1 (LMP1) using avidin-biotin immunoperoxidase complex technique. The staining results in Reed-Sternberg (R-S) cells and their variants were evaluated independently. HSP70 expression was found in R-S cells in 55 cases (85%) of HD examined and the frequency of HSP70 positive cases was significantly higher than that of HSP70 negative cases (P < 0.01). This protein was present in pathogenic cells in 9/12 cases (75%) of lymphocyte predominant Hodgkin's disease (LPHD), 21/27 cases (78%) of mixed cellularity Hodgkin's disease (MCHD), 10/10 cases (100%) of lymphocyte depleted Hodgkin's disease (LDHD) and 15/16 cases (94%) of nodular sclerosing Hodgkin's disease (NSHD). The association between HSP70 expression and HD thus appeared to be more frequent in patients wish LDHD and NSHD subtypes, although examples of HSP70-positive tumors were found in all histological subtypes. Studies of non-neoplastic lymphoid tissues demonstrated that centroblasts (large lymphocytes in germinal centers) were constantly positive; occasional histiocytes revealed variable reactivity for.

Functional expression of CD11a on CD8+ cells is suppressed in regional lymph nodes with cancer involvement in patients with gastrointestinal carcinoma

BACKGROUND

To evaluate the immunologic activity of regional lymph nodes, the phenotype of lymphocytes and the functional expression of cell adhesion molecules (CAMs) on lymph node lymphocytes (LNL-: uninvolved, LNL+: involved) were investigated in patients with gastrointestinal carcinoma.

METHODS

The lymphocyte subpopulation and the expression of CD11a, CD44, and CD29 on CD4+ and CD8+ cells in peripheral blood lymphocytes (PBL), LNL- and LNL+ derived from 37 patients with gastrointestinal carcinoma were studied. In addition, the adherence of CD8+ cells to ICAM-1 which reflects the adhesive function of CD11a, was examined, and changes in this adherence were studied by experimental coculture with cancer cells (DLD-1).

RESULTS

Although there were no differences in the overall proportion of T cells between the groups, CD8+ cells and CD16+ cells were considerably diminished in LNL+. The expression of CD11a and CD29 on CD4+ and CD8+ cells was significantly lower in LNL than in PBL, whereas the expression of CD44 showed no significant differences. The expression levels of these CAMs were almost the same in LNL- and LNL+. Only CD11a expression on CD8+ cells in LNL+ was significantly lower than that in LNL- (P < 0.005). The adherence of CD8+ cells in LNL+ to ICAM-1 was lower than that in PBL and LNL-, and was extremely enhanced by experimental coculture with cancer cells (DLD-1).

CONCLUSIONS

These data indicate that the functional expression of CD11a (LFA-1) on CD8+ T cells is suppressed in cancer-involved regional lymph nodes in patients with gastrointestinal carcinoma.

Molecular and genetic analysis of multiple changes in the levels of production of virulence factors in a subcultured variant of Streptococcus mutans

We previously isolated a variant strain, Xc100L, which shows decreased production of a surface protein antigen with a molecular mass of 190 kDa (PAc), after repeated subculturing of Streptococcus mutans strain Xc [Koga, T. et al. (1989) J.Gen. Microbiol. 135, 3199-3202]. In the present study, the levels of expression of the gtfB, gtfC, gtfD and ftf genes coding for polysaccharide-synthesizing enzymes in strain Xc100L were compared with those in strain Xc. Western blot analysis revealed multiple differences in the levels of production of these enzymes between these two strains. The amounts of the gtfB and gtfC gene products responsible for water-insoluble glucan synthesis in strain Xc100L were lower than those in strain Xc, whereas the amounts of the gtfD and ftf gene products responsible for water soluble glucan synthesis and fructan synthesis, respectively, in strain Xc100L were higher than those in strain Xc. Northern blot analysis revealed that the amounts of the four enzymes and PAc produced by strain Xc100L reflected the relative amounts of mRNAs from the genes. The chloramphenicol acetyltransferase gene was fused with each of these five genes, and the transcriptional activity of each gene in strain Xc100L was quantitatively compared with that in strain Xc. The chloramphenicol acetyltransferase assay also indicated that the phenotypic differences between strain Xc and strain Xc100L were due to differences in the transcriptional activities of the virulence genes. No differences in the nucleotide sequences of the promoter regions of the gtfB, gtfC, gtfD, ftf and pac genes were found between strain Xc and strain Xc100L. It is possible that a factor(s) affecting the levels of transcription of the multiple virulence genes exists in S. mutans.

Surgical treatment of isolated secundum atrial septal defect in patients more than 50 years old

BACKGROUND

Arrhythmia-related thromboembolic accidents continue to occur in patients even after closure of secundum atrial septal defect. Older age is usually not a contraindication to the repair of an atrial septal defect. To assess the importance of the type of management in elderly patients with atrial septal defect our clinical experience is reviewed.

METHODS

Between 1974 and 1994, 49 patients 50 years of age or older (average, 57.4 years) underwent surgical closure of secundum atrial septal defect. All patients have been followed up for 2 to 21 years (mean, 9.7 years).

RESULTS

There were no operative deaths. Functional classes in most of the patients were improved after operation. There were two cerebrovascular thromboembolic accidents with one permanent neurologic dysfunction, hemiparesis, and one septal dehiscence in the early postoperative period. One patient (2%) died of renal failure 6 years after operation, late arrhythmias developed in 3 patients (6%), 3 patients had a late stroke (6%), and 1 patient was not available for follow-up.

CONCLUSIONS

Long-term operative results are satisfactory and beneficial to the quality of life in elderly patients. Because there is no safe and effective nonsurgical alternative to surgical closure, atrial septal defect repair in elderly patients without severe pulmonary vascular disease should not be delayed once the diagnosis had been made.

Large-scale DNA typing for human platelet alloantigens by PCR-PHFA (preferential homoduplex formation assay)

Alloimmunization against human platelet alloantigens (HPA) is known to be involved in disorders such as neonatal alloimmune thrombocytopenic purpura, posttransfusion purpura, and refractoriness to platelet transfusion therapy. HPA typing is essential in diagnosis and management of patients. Therefore a reliable and speedy method is necessary for HPA typing. We have successfully applied a new DNA typing method, PCR-preferential homoduplex formation assay (PHFA) method, to typing for the HPA-1, -2, -3, -4, -5 and -6 systems. This method is based on DNA strand competition during hybridization under a precisely controlled temperature gradient between a double-labelled amplicon (standard DNA), prepared from biotin- and DNP-labelled primers, and an unlabelled amplicon (sample DNA). The results obtained by PCR-PHFA typing were in good agreement with the allotypes determined by serological typing and by other DNA typing methods. The PCR-PHFA method can be easily automated, is suitable for typing both small and large numbers of samples, and thus is applicable to routine HPA typing.

[Nonrheumatic calcification of the mitral valve in patients with stenotic calcified bicuspid aortic valve]

The pathogenesis of nonrheumatic calcification of the mitral valve was investigated by analyzing the clinical and echocardiographic characteristics of patients with mitral valvular calcification without any findings suggestive of rheumatic heart disease or infective endocarditis. Calcification of the mitral valve was observed in nine patients, who all had calcified stenotic (aortic valve area < 1 cm2) bicuspid aortic valve. Calcification of the mitral valve was localized to the basal portion of ventricular aspect of the anterior mitral leaflet and contiguous to that of the aortic valve. Mobility and thickness of the mitral leaflet was normal except for the calcified portion. Calcification of the mitral valve was not contiguous to posterior mitral annular calcification nor was related to direction of aortic regurgitant flow. In patients with calcified stenotic bicuspid aortic valve, calcification of the mitral valve was not associated with location of the two aortic cusps, aortic valve area, aortic valvular peak pressure gradient, direction of the left ventricular outflow, end-diastolic left ventricular outflow tract dimension, end-diastolic dimension of the aortic annulus, incidence of aortic regurgitation, calcification of the aortic arch, or risk factors of atherosclerosis. Six patients with mitral valvular calcification had aortic valve replacement. Preoperative coronary angiogram of these patients was normal. Calcification of the aortic valve was on the ventricular and aortic aspects. The calcification of the aortic valve, anterior mitral ring, or anterior mitral leaflet was not rheumatic in these six patients. Rheumatic disease, risk factors of atherosclerosis, mechanical stress by left ventricular outflow or aortic regurgitant flow, or mitral annular calcification did not appear to be related to mitral valvular calcification. The distribution of aortic and mitral valvular calcification suggested that the calcification of the mitral valve was due to progression of calcification of the bicuspid aortic valve.

Composite graft replacement of the aortic root in patients with Marfan's syndrome

Between October, 1979 and September 1994, 18 consecutive patients with Marfan's syndrome underwent replacement of the ascending aorta and aortic valve with a composite graft. There were 11 men and seven women; the mean age was 38.7 years. All patients had annuloaortic ectasia with significant aortic regurgitation. Ten of the 18 patients had aortic dissection. Concomitant procedures were performed in three patients. The hospital mortality rate was 17%, and two patients with concomitant procedures died early after surgery. There were three late deaths, two of which were related to late aortic complications. The actuarial 8-year survival rates in patients with and without aortic dissection were 58.3% and 77.8%, respectively. Since aortic dilatation and its complications are progressive in patients with Marfan's syndrome, improved surgical results can be obtained early in the course of the disease before cardiac disturbances and aortic dissections emerge.

Association of TAP1 and TAP2 with systemic sclerosis in Japanese

OBJECTIVE

The contribution of polymorphism of transporter associated with antigen processing 1 and 2 (TAP1 and 2) alleles to the pathogenesis of Japanese SSc was studied.

METHODS

TAP1 and TAP2 typing was carried out in 55 Japanese SSc patients and 95 normal Japanese subjects by the PCR-RFLP (restriction fragment length polymorphism) method. HLA-DR typing and HLA DRB1*15, *16 and *08 genotyping were carried out by the PCR and the PCR-SSCP (single-stranded DNA conformation polymorphism) methods, respectively.

RESULTS

The frequencies of the TAP1A and TAP2A alleles were significantly increased in SSc with diffuse scleroderma (100%, p < 0.005; 80.0%, p < 0.001, respectively) and in SSc with antitopoisomerase 1 antibody (a-Scl-70), (93.2%, p = not significant (NS); 63.6%, p < 0.05). In contrast, the TAP1B allele was significantly decreased in diffuse scleroderma (0%, p < 0.005) and SSc with a-Scl-70 (4.5%, p < 0.05), and TAP2B was decreased in diffuse scleroderma (12.5%, p < 0.01).

CONCLUSION

Association analysis among TAP1A, TAP2A and DRB1*1502 indicated that increases in TAP1A and TAP2A were not primary, but were reflective of an increase in HLA DRB1*1502 in Japanese SSc patients with diffuse scleroderma and SSc with a-Scl-70.