Opioids in myocardial ischaemia: potentiating effects of dynorphin on ischaemic arrhythmia, bradycardia and cardiogenic shock following coronary artery occlusion in the rat

The endogenous opioid peptide (EOP) dynorphin and opioid receptors have been found in the heart. This opioid system plays important roles in cardiovascular regulation and is involved in the pathophysiology of shock, heart failure and myocardial ischaemia. The aim of this study was to evaluate whether the EOP dynorphin modulates or potentiates ischaemia-induced arrhythmias and whether its effects are prevented by the opiate antagonist naloxone. Following coronary artery occlusion, all rats in the control group developed ischaemia-induced arrhythmias, bradycardia and hypotension, which were significantly potentiated by pre-treatment with dynorphin and attenuated by treatment with naloxone. The results clearly indicate that EOPs may be released when myocardial ischaemia occurs, thus causing arrhythmias, bradycardia and hypotension. Dynorphin and naloxone, by virtue of their opioid agonistic and antagonistic actions, respectively, potentiate and attenuate these fatal complications secondary to myocardial ischaemia. This suggests that EOPs play an important part in ischaemic heart disease.

Beneficial effects of the opiate antagonist naloxone on hemodynamics and ventricular function following coronary artery occlusion and reperfusion in the dog

It has been shown that endogenous opioid peptides (EOP) subserve important roles in cardiovascular regulation and are involved in the pathophysiology of myocardial ischemia, contributing to the deleterious effects. The aim of this study was to evaluate the effects of the opiate antagonist naloxone on the hemodynamics and ventricular function following coronary artery occlusion and reperfusion in the dog, utilizing the technique of cardiac catheterization. During myocardial ischemia and reperfusion, it was found that in the control group, there was reduction in the aortic, left ventricular, right atrial, pulmonary arterial and wedge pressures, and in the left ventricular dP/dt. The reduction in the aortic, left ventricular and pulmonary arterial pressures, and left ventricular dP/dt were significantly attenuated by pretreatment with naloxone. The results indicate a regulatory role of EOP in the cardiovascular function and suggest a possible involvement of EOP in myocardial ischemia and reperfusion causing detrimental effects such as arrhythmias, bradycardia, hypotension and, as shown in this study, impaired hemodynamics and ventricular function. The beneficial effects of naloxone on circulatory dynamics may have clinical implications in the prevention and treatment of ischemic heart disease.

In vitro IgE production by interleukin 4-stimulated human peripheral blood mononuclear cells is suppressed by rapamycin

Rapamycin (RAPA) is a new immunosuppressant which is 50-fold to 100-fold more potent than cyclosporin A (CyA) in inhibiting cellular immune responses and allograft rejection in animal models of organ transplantation. The drug's effect on in vitro IgE synthesis by interleukin (IL)4-stimulated human peripheral blood mononuclear cells was examined and compared with CyA's effect in this study. RAPA was found to be about 100-fold more potent than CyA in inhibiting IgE synthesis. Its inhibitory effect on IgE production was significant if it was added to the culture before Day 6 of a 14-day culture. The suppression was accompanied by the inhibitory effect on cell proliferation and on IgE-binding factor (IgE-BF) production. IL2 was able to partially reverse CyA- but not RAPA-induced inhibition of IgE production. Commercial B cell growth factor (cBCGF) was not able to reverse either RAPA- or CyA-induced suppression of IgE synthesis. The strong inhibitory effect of RAPA in IgE synthesis may be useful in certain clinical applications where overproduction of pathogenic IgE is a key issue. RAPA can also be used as a tool to dissect the regulation of IgE production.

Cis-active determinants of cardiac-specific expression in the human atrial natriuretic peptide gene

Expression of the human atrial natriuretic peptide (hANP)gene is controlled by a series of positive and negative cis-acting regulatory elements present in the 5' flanking sequences (5'FS) of the gene. Positive elements located between -1150 and -222, relative to the transcription start site, appear to be responsible for the major portion of ANP gene expression in neonatal rat cardiac atrial cells. While neonatal ventricular cardiocytes, at a qualitative level, seem to employ regulatory signals similar to their atrial counterparts, they do so with reduced efficiency. Expression of the hANP gene in nonmyocardial cells is limited by the presence of silencer elements in the distal (-2593 to -1150) and proximal (-222 to the CAP site) 5'FS. Further characterization of a 64-base pair cardiac-specific element (-410 to -332), described previously, revealed that a core sequence of 40 base pairs is required for functional activity. This core sequence includes a previously defined DNAse-I footprint region flanked by two GC-rich segments arranged in an inverted repeat-like array. These findings suggest that the disparity in atrial vs. ventricular cardiocyte expression of the ANP gene reflects differences that are largely quantitative in nature, while differences in myocardial vs. nonmyocardial cells result from fundamental qualitative differences in the way these cells recognize and use the regulatory elements present within the 5'FS.

1,25(OH)2 vitamin D3 inhibits the CD23 gene expression by human peripheral blood monocytes

A biologically active form of vitamin D, 1,25(OH)2D3, and a leukocyte surface molecule, CD23, play important roles in immune regulation. The effect of 1,25(OH)2D3 on the CD23 gene expression was examined in this study. The results show that 1,25(OH)2D3 suppresses spontaneous and IL-4-stimulated CD23 synthesis by peripheral blood monocytes. The inhibition occurs at both the protein and mRNA levels. However, 1,25(OH)2D3 has no inhibitory effect on CD23 production by either resting or activated tonsillar B cells. Our results suggest a possible role of 1,25(OH)2D3 in the regulation of certain immune and inflammatory responses via its effect on CD23 production.

1,25(OH)2 vitamin D3 inhibits the CD23 gene expression by human peripheral blood monocytes

A biologically active form of vitamin D, 1,25(OH)2D3, and a leukocyte surface molecule, CD23, play important roles in immune regulation. The effect of 1,25(OH)2D3 on the CD23 gene expression was examined in this study. The results show that 1,25(OH)2D3 suppresses spontaneous and IL-4-stimulated CD23 synthesis by peripheral blood monocytes. The inhibition occurs at both the protein and mRNA levels. However, 1,25(OH)2D3 has no inhibitory effect on CD23 production by either resting or activated tonsillar B cells. Our results suggest a possible role of 1,25(OH)2D3 in the regulation of certain immune and inflammatory responses via its effect on CD23 production.

Extracellular calcium regulates expression of the gene for atrial natriuretic factor

Primary cultures of neonatal rat cardiocytes were exposed for 24 hours to culture media containing 0-2.0 mM extracellular calcium. Both atrial natriuretic factor (ANF) messenger RNA (mRNA) and ANF secretion were increased approximately threefold in the presence of 2.0 mM CaCl2 (vs. Ca2(+)-free medium). When cardiocytes were treated with the calcium channel blockers diltiazem, nifedipine, or verapamil, both ANF synthesis and secretion fell to 25-40% of control values. The choice of transcription start site on the ANF gene was not altered by the calcium channel blockers. When exogenous calcium was added to cardiocytes treated with verapamil, secretion of ANF was partially restored to control levels. High-performance liquid chromatographic analysis of medium from cardiocytes exposed to varying extracellular calcium concentrations or treated with calcium channel blockers for 24 hours revealed that the majority of secreted immunoreactivity (60-70%) migrated with pro-ANF (17 kDa) and that none of the various experimental manipulations significantly changed the ratio of pro-ANF to ANF in the media. These results were confirmed by immunoprecipitation analysis of the culture medium from the individual treatment groups. Treatment of cardiocytes for 24 hours with either the calcium ionophore A23187 or the phorbol ester 12-O-tetradecanoylphorbol 13-acetate increased ANF secretion. The combined use of these agents resulted in stimulation of both ANF secretion and ANF mRNA accumulation.

[The incidence of multi-organ involvement in urothelial malignancies]

Attention has long been drawn on the multi-organ involvement of urothelial malignancies both by urologists and pathologists. Urothelial malignancies did occur occasionally in several urinary organs within the same patient. From 1951 to 1986, 12,553 patients were admitted to our urological department, among them 1,213 had urothelial tumors. There were renal pelvic tumors in 130, ureteral in 93, bladder in 925 and urethral in 65. We measured any single individual of the paired-organ, the pelvis or ureter as a single organ. Thus, of the total 1,213 tumors 113 were found to have multi-organ involvement. Long term follow-up rate was 93.6%. In the present study, we noted that the malignant appearance of urothelium involving in multi-organ has generally been with a trend toward urinary flow. i.e. from the proximal to the distal site of urinary tract. One hundred and four patients (92%) had tumors developed the urinary flow direction while only 9 patients (8%) were of refluent direction. Renal pelvis, ureter and urethra showed to be at high preference of multi-organ involvement, accounting for 53.8%, 58.1% and 46.2% respectively, whereas bladder tumor only showing 10.5%, predominated in single organ involvement.

Perinatal expression of the atrial natriuretic factor gene in rat cardiac tissue

The expression of the atrial natriuretic factor (ANF) gene was examined in the perinatal rat ventricle. The late fetal ventricle (day -3 relative to parturition) demonstrated a modest level of ANF gene expression. This expression increased at the time of birth and peaked on day +1 after birth. Atrial ANF immunoreactivity (irANF) increased gradually during the postpartum period (day +1 to 2-3 wk of age), while ventricular irANF as well as ventricular ANF mRNA levels fell over the same interval. This decrease in ANF gene expression resulted from a decrease in activity of the same major transcription start site employed in the adult atria and ventricle. Plasma irANF levels were very high in the neonatal period and decreased over the ensuing 2-3 wk, a profile similar to that seen for ventricular ANF gene expression. In situ hybridization histochemistry revealed that, while adult rat ventricular ANF mRNA was predominantly confined to the subendocardial layer, neonatal ventricles expressed the ANF gene throughout approximately 50% of the inner wall thickness. These findings suggest that the ANF gene is responding to regulatory stimuli that appear at or near the time of parturition and dissipate in the early neonatal period.

Upstream sequences confer atrial-specific expression on the human atrial natriuretic factor gene

5'-Flanking sequences from the human atrial natriuretic factor (hANF) gene were subcloned into a reporter plasmid (pSVOCAT) and transfected into primary cultures of neonatal rat atrial cardiocytes. Hybrid hANFCAT genes containing either 2500 or 409 base pairs of 5'-flanking sequence DNA were expressed at similar levels. When sequences between -409 and -332 were deleted, reporter gene (CAT) activity decreased significantly. Expression of the hANFCAT constructs was specific for atrial cells, as no expression was detected in primary cultures of ventricular cardiocytes or nonmyocardial cells derived from the neonatal hearts. Correct transcription start sites for the transfected hANF genes were confirmed by S1 nuclease mapping and RNase protection analysis. A "gel shift" assay was used to identify a specific cardiac nuclear protein which bound to the 5'-flanking sequence of the hANF gene. A 192-base pair PvuII fragment (-400 to -208) associated with a protein in these extracts in a tissue- and sequence-specific fashion. These findings indicate that the DNA sequence between -409 and -332 in the hANF gene harbors a tissue-specific element whose activity may involve association with a cardiac-specific nuclear protein.

Demonstration of intracytoplasmic IgE in circulating lymphocytes of allergic individuals

Cells containing intracytoplasmic IgE (IC IgE) were demonstrated in the peripheral blood mononuclear cells of atopic individuals by means of indirect immunofluorescence, employing mouse monoclonal anti-human IgE antibody. IC IgE-positive cells are low-density B cells as shown by centrifugation on discontinuous bovine serum albumin density gradient and by their reactivity with B1 monoclonal antibody specific to B lymphocytes, respectively. Further characterization of these cells by means of a rosette assay employing anti-Ig-coupled bovine erythrocytes indicated that these cells were surface IgE (sIgE) positive and sIgM negative. The data strongly suggest that activated IgE B cells are circulating in the blood of allergic individuals.

Massive osteolysis of the skull: long-term follow-up observations after cranioplasty. Report of two cases

Two cases of massive osteolysis involving the cranial vault are presented. Unlike disappearing bones in other regions, it is vital to protect the brain from injury by performing cranioplasty once the bone loss has reached a reasonable extent. This appears to be the first report on surgical management in massive osteolysis of the skull. Long term follow-up results are given. The diagnosis and differentiation from related conditions are discussed.

Inflammatory pseudo-tumours of the abdomen: plasma cell granulomas

Pseudo-tumours of the plasma cell granuloma type are reported in two patients. One was retroperitoneal and the other intraabdominal. Most of the cases of plasma cell granulomas described in the literature have been in the lung (Brunn, 1939; Childress and Adie, 1950; Cotton, 1952; Umiker and Iverson, 1954; Lane, Krohn, Kolozai, and Whitehead, 1955; Liebow and Hubbell, 1956; Titus, Harrison, Clagett, Anderson, and Knaff, 1962; Mason, Keats, and Baker, 1963; Wentworth, Lynch, Fallis, Turner, Lowden, and Conen, 1968; Bahadori and Liebow, 1973). A retroperitoneal site has not to our knowledge been reported previously. The postinflammatory nature of such lesions and the significance of a previous history of abdominal surgery are emphasized. It is important to be aware of such benign lesions which may simulate malignant tumours so that unnecessary radical treatment can be avoided.