Continuous perfusion of pulmonary arteries during total cardiopulmonary bypass favorably affects levels of circulating adhesion molecules and lung function

OBJECTIVES

Lung injury is a serious complication of cardiopulmonary bypass in infants with congenital heart disease and pulmonary hypertension. Cessation of blood flow in the pulmonary arteries during cardiopulmonary bypass is known to provoke lung dysfunction. We assessed the effect of continuous pulmonary perfusion on circulating adhesion molecules and on lung function.

METHODS

Fourteen infants with congenital heart disease and pulmonary hypertension were enrolled in the study. During total cardiopulmonary bypass, 8 patients underwent continuous perfusion of the pulmonary arteries (perfusion group), and the remaining 6 patients did not (control group). Plasma levels of circulating intercellular adhesion molecule 1, soluble granule membrane protein 140, and sialyl Lewis(x) and PaO (2)/fraction of inspired oxygen ratios were measured before commencement and serially for 24 hours after termination of bypass.

RESULTS

Plasma levels of circulating intercellular adhesion molecule 1 decreased significantly at the termination of bypass in both groups but returned to prebypass levels immediately in the control group, whereas in the perfusion group the values remained significantly less than those before bypass. Plasma levels of soluble granule membrane protein 140 in the control group were significantly higher at 6 and 12 hours after bypass than levels before bypass, whereas in the perfusion group the values remained at the prebypass level throughout the postbypass period. Trends of plasma levels of sialyl Lewis(x) were alike in both groups. PaO (2)/fraction of inspired oxygen ratios in the control group decreased significantly from 6 hours after bypass, whereas values in the perfusion group remained at the prebypass value throughout the postbypass period.

CONCLUSIONS

This study suggests that in infants having congenital heart disease and pulmonary hypertension, continuous pulmonary perfusion during total cardiopulmonary bypass minimizes ischemic insult and neutrophil-endothelial interaction mediated by adhesion molecules in the pulmonary microvessels.

FTS reduces bleomycin-induced cytokine and chemokine production and inhibits pulmonary fibrosis in mice

Bleomycin (BLM), an antitumour drug, is known to cause interstitial pneumonia followed by pulmonary fibrosis, and has often been used to produce an animal model of pulmonary fibrosis. In the present study, we examined the effect of a nonapeptide thymic hormone, facteur thymique serique (FTS), on the murine lung fibrosis induced by intratracheal instillation of BLM. Treatment with FTS ameliorated BLM-induced fibrotic changes in a dose-dependent manner, as indicated by the reduced accumulation of hydroxyproline (HP). In addition, FTS suppressed BLM-induced cellular inflammatory response in the lungs, as evidenced by inhibition of increased lung weight, reduced accumulation of inflammatory leucocytes, including lymphocytes and neutrophils, but not macrophages, and less pronounced histopathological changes. Finally, BLM challenge increased the local synthesis of proinflammatory cytokines, TNF-alpha and IL-1beta and chemokines, MCP-1, MIP-1alpha RANTES, MIP-2 and KC, while administration of FTS suppressed the production of these cytokines, except for MCP-1. These effects of FTS were observed only when mice received intratracheal instillation with BLM. Considered collectively, our results indicated that FTS treatment ameliorated the cellular inflammatory responses and fibrotic changes in the lungs caused by BLM and such inhibition was well correlated with reduced synthesis of several fibrosis-related cytokines, and suggested that FTS may be potentially useful for the treatment of pulmonary fibrosis.

Two cases of long lasting bacteremia due to Mycobacterium avium complex despite new macrolides-containing regimens in patients with acquired immunodeficiency syndrome

The prognosis of Mycobacterium avium complex (MAC) infection has been improved by new macrolides-containing regimens and the use of highly active antiretroviral therapy (HAART) in the treatment of acquired immunodeficiency syndrome (AIDS). We report on two AIDS cases with long lasting bacteremia due to MAC under this regimen. Both patients experienced problems due to side effects from the anti-MAC regimen and from an immune-reconstitution syndrome related to HAART. MAC infection persisted despite treatment, however, no anti-MAC drug-resistant isolates emerged throughout the clinical course in either case. These cases demonstrate that therapy for disseminated MAC infection is sometimes difficult even with HAART and macrolides-containing regimens.

Complications during clinical courses of Pneumocystis carinii pneumonia in patients with acquired immunodeficiency syndrome

OBJECTIVE

To describe the incidence of complications before and during therapy of Pneumocystis carinii pneumonia (PCP) in patients with acquired immunodeficiency syndrome (AIDS).

METHODS

A retrospective review of the patient's medical records.

PATIENTS

A total of 29 patients with AIDS and PCP who were admitted to the AIDS Clinical Center, International Medical Center of Japan from July 1996 to November 1999.

RESULTS

Adverse effects were found in 24 (88.9%) of 27 patients treated with trimethoprim/sulfamethoxazole (T/S), 6 (46.1%) of 13 treated with parenteral pentamidine, and 2 (20%) of 10 treated with inhaled pentamidine. Infectious and/or non-infectious complications were found in 25 (86.2%) of 29 study patients. Regarding infectious complications, 16 (55.2%) were found on admission and 10 cases (34.5%) with infectious complications were identified during admission; including oral candidiasis (37.9% and 17.2%, respectively) and genital herpes (3.4% and 6.9%, respectively). Cytomegalovirus antigenemia was detected in 4 cases (13.8%) on admission and 12 cases (41.4%) during admission. Non-infectious complications affected 11 cases (37.9%) on admission, and 6 cases (20.7%) during admission, the latter included heart failure (10.3%) and pneumothorax (6.9%). PCP was successfully treated in all but one patient who suffered from repeated pneumothorax.

CONCLUSION

Treatment of PCP can be problematic and it is important to be aware of the high incidence of various complications that can occur during the treatment of PCP.

Chromosomal and extrachromosomal synthesis of exfoliative toxin from Staphylococcus hyicus

Evidence for the existence of two molecular species of exfoliative toxin (ET) synthesized by Staphylococcus hyicus (SHET) under chromosomal and plasmid control is presented. Serological evidence that these molecular species of toxins are distinct from each other is given. The molecular weights of SHET from plasmidless strain P-1 (SHETA) and from plasmid-carrying strains P-10 and P-23 (SHETB) were almost equal. Both of the serotypes of SHET exhibited exfoliation in 1-day-old chickens. The plasmid-cured (P(-)) substrains (P-23C1 and P-23C2) of S. hyicus P-23 did not cause exfoliation in 1-day-old chickens, whereas P(-) substrains (P-10C1 and P-10C2) of strain P-10 caused exfoliation, but they decreased their exfoliative activity. These findings suggest that SHETB was synthesized along with SHETA by strain P-10, whereas the P-23 strain synthesized SHETB alone. The plasmid-carrying strain (P-23) as well as the plasmidless strain (P-1) exhibited the typical clinical signs of exudative epidermitis in pigs. However, plasmid-cured (P(-)) substrains of P-23 (P23C1 and P23C2) did not exhibit the typical clinical signs of exudative epidermitis. These findings suggest that SHETA is synthesized under chromosomal control and SHETB is synthesized under plasmid control and that SHET-producing strains can be divided into three groups: SHETA-producing strains, SHETB-producing strains, and strains producing both toxins.

A novel method for assessing assisted female fertility: bioelectric impedance

Early detection of declining female fertility is important for effective prevention and treatment of infertility. Age, serum concentration of FSH in the early follicular phase (basal FSH), and the clomiphene citrate (CC) challenge test correlate only with large declines in fertility. We serendipitously discovered that by a novel mechanism bioelectric impedance (BEI) sensitively reflects early fertility decrements. BEI was measured between the right and left arms by the tetrapolar method before and during ovarian stimulation for in vitro fertilization (IVF). In a stepwise multiple logistic regression analysis of five factors (BEI on luteal day 4 prior to the IVF cycle [BEI-L4], age, basal FSH, body height, and body mass index), BEI-L4 alone was a significant predictor (P<0.05) of achievement of pregnancy by IVF in 148 women (74 pregnant and 74 nonpregnant). BEI showed a nadir on the day of administration of hCG in the pregnant but not the nonpregnant group. Serum concentrations of VEGF during ovarian stimulation were significantly higher in the pregnant group, but not those of 17beta-estradiol and progesterone. The CC challenge test revealed no significant difference between 11 pregnant and 15 nonpregnant women. The clinical usefulness of BEI was evaluated in 272 consecutive IVF cycles. Rate of pregnancy was significantly higher (P<0.01) in IVF cycles with BEI-L4 > or =600 Ohms than <600 Ohms (44% and 26% in 149 and 123 cycles, respectively). When BEI-L4 was > or =600 Ohms, pregnancy rates were constantly high irrespective of age and basal FSH. In prediction of nonpregnancy, sensitivity of BEI-L4 (0.52) was significantly (P<0.05) higher than those of age and basal FSH (0.39 and 0.046, respectively). BEI, which is easy, noninvasive, and inexpensive, predicts female fertility more sensitively than age and basal FSH, probably reflecting angiogenic capacity of reproductive organs.

Association between alcohol intake and subjective health: the Sotetsu Study

Subjective health and alcohol intake are important predictors of mortality. There have been few epidemiological studies, however, of the relationship between alcohol consumption and subjective health among the Japanese. The purpose of this study is to investigate the association between alcohol consumption and subjective health. The study subjects were 2,020 Japanese male employees, who were free from serious disease conditions. The data on subjective health and alcohol consumption were obtained by means of self-reported questionnaire. The subjects who responded "poor health" in the answer to the question about the subjective health status were considered to be in ill-health. Ethanol intake per day was calculated by multiplying the frequency of drinking by the ethanol intake per drinking occasion and summing up for each alcoholic beverage. Age, smoking status, physical activity, and sleeping hours were treated as confounding factors. As a result, subjects who consumed 25-36 or 49 g ethanol or more per day had a significantly lower risk of self-rated ill-health compared with those who had never drunk, and a significantly inverse trend was found independent of age, smoking status, physical activity, and sleeping hours. In conclusion, moderate drinkers have a lower risk of self-rated ill-health among Japanese male employees investigated.

Efficient production of recombinant human erythropoietin by replenishment of microcarriers in the hollow fiber culture cassette

Human erythropoietin (EPO)-producing recombinant BHK cells were cultured in culture medium containing microcarriers, and then microcarriers attached with cells were replenished in the hollow fiber culture cassette. By culture for 14 days, it was possible to produce 450 micrograms of the recombinant EPO, which corresponded to over two-fold of the recombinant EPO production by control hollow fiber culture without microcarriers.

Improved segmental isotope labeling of proteins and application to a larger protein

A new isotope labeling technique for peptide segments in a protein sample was recently established using the protein splicing element intein [Yamazaki et al. (1998) J. Am. Chem. Soc., 120, 5591-5592]. This method makes it possible to observe signals of a selected amino (N-) or carboxyl (C-) terminal region along a peptide chain. However, there is a problem with the yield of the segmentally labeled protein. In this paper, we report an increase in the yield of the protein that enables the production of sufficient amounts of segmentally 13C/15N-labeled protein samples. This was achieved by improvement of the expression level of the N-terminal fragment in cells and the efficiency of refolding into the active splicing conformation. The N-terminal fragment was expressed as a fused protein with the cellulose binding domain at its N-terminus, which was expressed as an insoluble peptide in cells and the expression level was increased. Incubation with 2.5 M urea and 50% glycerol increased the efficiency of the refolding greatly, thereby raising the final yields of the ligated proteins. The feasibility of application of the method to a high-molecular-weight protein was demonstrated by the results for a maltose binding protein consisting of 370 amino acids. All four examined joints in the maltose binding protein were successfully ligated to produce segmentally labeled protein samples.

Association between duration of obesity and risk of non-insulin-dependent diabetes mellitus. The Sotetsu Study

The authors investigated the association between duration of obesity (ordinary obesity as body mass index (BMI) (kg/m2) > or = 25.0 and extreme obesity as BMI > or = 27.8) and the risk of diabetes mellitus. Male employees of a railway company, aged 30 years or older, observed for 10 years or more, free from serious disease conditions, with initial BMI <25.0, aged 30 years or more at the time diabetes was diagnosed, and with complete data, were examined by univariate and multivariate analyses (n = 1,598). Age-adjusted odds ratios for diabetes were significantly increased among males who were obese for 10-19.9 years and >20 years (odds ratios = 2.10 and 2.84 for ordinary obesity and 6.14 and 4.15 for extreme obesity, respectively). Additional adjustment for current obesity, physical activity, smoking, drinking, family history, and observation period did not change the findings remarkably. In conclusion, > or = 10 years duration of ordinary obesity or > or = 1 year of extreme obesity was an important predictor for diabetes independent of age, current obesity, physical activity, smoking, drinking, family history, and observation period.

Cell hybridization, hybridomas, and human hybridomas

Cell hybridization is one of the most basic cytotechnologies. The hemagglutinating virus of Japan was first used to cause cell fusion; however, polyethylene glycol is widely used now because of simplicity of procedure. This chapter first explains the principles of cell hybridization methods and then describes the practical protocols for preparing mouse hybridomas using polyethylene glycol. So far, lack of an excellent human fusion partner cell line that has high fusion efficiencies and does not produce immunoglobulin has hindered the spread of human-human hybridoma preparation methods. In the authors' laboratory NAT-30 and HO-323, human parent cell lines with high fusion efficiencies, have been established to prepare many hybridoma cell lines producing cancer-specific human monoclonal antibodies. Because NAT-30 and HO-323 cell lines are IgM producers, it is difficult to obtain IgG-producing hybridomas because the types of immunoglobulin produced by hybridomas are strongly affected by the characteristics of parent cells. Thus a nonimmunoglobulin-producing human parent cell line, A4H12, derived from human T lymphoma was established that can efficiently obtain IgG-producing human hybridomas. Another problem with preparing human hybridomas is that it is difficult to obtain B lymphocytes immunized with optional antigens for ethical reasons. To overcome this problem, in vitro immunization methods have been developed that allow exposure of a large number of B lymphocytes to cultured cancer cell or soluble antigens. The section on human hybridomas explains human fusion partners, in vitro immunization methods, and the preparation of human-human hybridomas using an electrofusion method. Finally, the application of human monoclonal antibodies to medical uses and the preparation of supranatural monoclonal antibodies are reviewed. These include multifunctional monoclonal antibodies and altered monoclonal antibodies having increased affinity and specificity by exchanging or modifying light chains.

Prevalence and risk factors of allergic rhinitis and cedar pollinosis among Japanese men

BACKGROUND

Although recent reports show a worldwide increase in allergic diseases during the past 10-20 years, few epidemiological studies on secular trend and the age-specific prevalence of allergic rhinitis have been carried out in Japan. We conducted a study to clarify the age-specific prevalence of allergic rhinitis and cedar pollinosis to provide baseline data for a prospective study and to investigate the association of rhinitis with both environmental and personal factors among 2,307 Japanese men.

METHODS

Allergic rhinitis was determined from self-reported allergic rhinitis or from the seasonal symptoms of the nose. Seasonal rhinitis was defined as symptoms evoked in the subjects from February to May. Cedar pollinosis was defined as the presence of cedar-specific IgE positivity among subjects with seasonal rhinitis.

RESULTS

The prevalences of allergic rhinitis, seasonal rhinitis, and cedar pollinosis were 35.5, 28.8, and 11.0%, respectively. Age was a negative risk factor for all allergic conditions. Allergic family history and residence along a main street were strong risk factors for all allergic rhinitis.

CONCLUSIONS

The current prevalence of each rhinitis was higher than previously reported. The risk factors were similar for each allergic rhinitis except for a past history of atopy.

Relation between obesity in young adulthood and risk of non-insulin-dependent diabetes mellitus

OBJECTIVE

To investigate the independent effect of obesity in young adulthood on the risk of non-insulin-dependent diabetes mellitus (NIDDM).

DESIGN

Retrospective cohort design.

SUBJECTS

One-thousand, one hundred and five Japanese male railway employees aged 30 y or older who received a health examination from February to May 1995.

MEASUREMENTS

Adjusted odds ratios (ORs) for subsequent NIDDM determined by the WHO criteria or a physician's diagnosis, among men who were obese at ages 20, 25, or 30 y.

RESULTS

Men who were obese (BMI > or = 25.0 kg/m2) at ages 25 or 30 y had significantly positive ORs for NIDDM after adjustment for age and maximum BMI (8.20 and 3.94, respectively). Men in the top quintile of BMI at any age also had significantly positive ORs for NIDDM (2.13, 7.92, and 3.49, at 20, 25, and 30 y, respectively). After mutual adjustment for BMI at age 20, 25 and 30 y, only obesity at age 25 y demonstrated a significantly positive OR for NIDDM in both absolute and relative models (6.98 for BMI > or = 25.0 and 9.99 for the top quintile, respectively).

CONCLUSION

Men who were obese (BMI > or = 25.0 kg/m2 or top quintile) at age 25 y were at significantly high risk of prevalent NIDDM in subsequent years, independent of age, maximum BMI, and BMIs at age 20 and 30 y.

Relationship between weight change in young adulthood and the risk of NIDDM. The Sotetsu Study

OBJECTIVE

To investigate the independent effect of weight change in young adulthood on the risk of prevalent NIDDM among middle-aged Japanese men.

RESEARCH DESIGN AND METHODS

A case-control study was carried out in 895 male employees aged > or = 30 years of a railway company located in the vicinity of Tokyo. Adjusted odds ratios (ORs) were calculated for prevalent diabetes in each category of weight change (obtained from subjects' medical records) in young adulthood and adulthood. Adjustment for current age, initial BMI, and weight change in each age stratum was performed by the Mantel-Haenszel method or multiple logistic regression analysis.

RESULTS

Weight change between 20 years of age and the age at maximum weight was not associated with the risk of NIDDM. Weight gain between 20 and 25 years of age was significantly and positively associated with the risk of NIDDM (OR 3.87 for gains > or = 10.0 kg, 2.53 for gains of 5.0-9.9%, and 3.73 for gains > or = 10.0%). On the other hand, moderate weight gain after 30 years of age was significantly inversely associated with NIDDM (OR 0.44 for gains of 5.0-9.9 kg, 0.15 for gains of 10.0-19.9%, and 0.38 for gains of 20.0-29.9%).

CONCLUSIONS

Extreme weight gain between 20 and 25 years of age is a significant predictor of NIDDM, independent of current age, BMI at 20 years of age, and weight change within other age strata.

The effectiveness of a hospital-based program to promote exclusive breast-feeding among low-income women in Brazil

OBJECTIVES

This study examined the effectiveness of a hospital program to promote exclusive breast-feeding in Santos, Brazil.

METHODS

In a prospective design, women who delivered at a hospital with an active breast-feeding promotion program (n = 236) were compared with women who delivered at a nearby control hospital (n = 206).

RESULTS

The two groups had similar demographic characteristics and previous breast-feeding histories. Exposure to breast-feeding activities, assessed by maternal recall prior to discharge, was universally high at the program hospital and universally low at the control hospital. Multivariate survival analysis showed that exclusive breast-feeding lasted 53 days longer among women who delivered at the program hospital.

CONCLUSIONS

Hospital-based breast-feeding promotion programs may be effective in extending the duration of exclusive breast-feeding.

Production of recombinant human monoclonal antibody using ras-amplified BHK-21 cells in a protein-free medium

A ras oncogene-amplified recombinant BHK-21 cell line (ras-rBHK-IgG) has been established, and was shown to hyperproduce the recombinant IgG chimeric human monoclonal antibody (hMAb) AE6F4, which recognizes lung cancer cells. We found that the ras-rBHK-IgG cell could be easily cultured in a protein-free ERDF medium supplemented with iron(III) nitrate, hydroxyethyliminodiacetic acid, and non-protein synthetic attachment factor as well as in a serum-free ERDF medium supplemented with insulin, transferrin, ethanolamine, and sodium selenite. The productivity of recombinant hMAb from the cells cultured in dishes at high cell densities was higher in protein-free medium than in serum-containing medium. True high density culture of the ras-rBHK-IgG cells was done in protein-free medium using the Tecnomouse, which is a novel hollow fiber bioreactor system. After culture for 30 days in protein-free culture, a total amount of about 14 mg of the recombinant hMAb AE6F4 was obtained, and was shown to be reactive against lung cancer cells in tissues.

Modified antigen-binding of human antibodies with glycosylation variations of the light chains produced in sugar-limited human hybridoma cultures

We have characterized the effects of serum and N-acetylglucosamine in a glucose-deprived condition on the glycosylation of antibody light chains, as well as the resulting biological properties of those antibodies. We have chosen for our investigation the human hybridoma lines producing monoclonal antibodies reactive to lung adenocarcinoma. Each antibody possess a N-glycosylated carbohydrate chain in the hypervariable region of the light chains. When the cell lines were grown in the absence of glucose, variant light chains with varying molecular masses were found to be secreted. Analysis of these light chains produced in a glucose-deprived condition revealed that the changed molecular-mass of the variant light chains is due to different glycosylation. Addition of N-acetylglucosamine or fetal calf serum to the glucose-free medium led to the creation of other light chains that exhibit increased antigen binding activity.

Persistence of hepatitis C virus RNA in established human hepatocellular carcinoma cell lines

The persistence of the viral RNA of hepatitis C virus (HCV) was examined in 13 hepatocellular carcinoma (HCC) and two hepatoblastoma cell lines by reverse transcription followed by the polymerase chain reaction (RT-PCR). HCV RNA was detected in three HCC lines (JHH-1, JHH-4, and JHH-6) and negative-strand viral RNA was found in JHH-4, indicating that there is a putative replicative intermediate of HCV in JHH-4 cells. To rule out the possibility of contamination, the partial nucleotide sequences of HCV-specific PCR products of these three cell lines were determined. The clone from JHH-1 belonged to genotype 1 (1a or 1b), and the clones from JHH-4 and JHH-6 belonged to genotype 2b, but their sequences differed from each other. These cell lines may be useful for studies related to HCV.

Contribution of interferon-gamma in protecting mice during pulmonary and disseminated infection with Cryptococcus neoformans

In the present study, the role of interferon-gamma (IFN-gamma) in the host resistance against Cryptococcus neoformans was examined using a murine model of pulmonary and disseminated infection. In this model, mice were infected intratracheally with live yeast cells, and the histological changes in the lungs and the number of microorganisms in the lung and brain were compared in mice treated and untreated with anti-IFN-gamma monoclonal antibody (mAb) to define the contribution of endogenously synthesized IFN-gamma in the natural course of infection. Administration of this mAb reduced the accumulation of inflammatory cells in the alveolar septa, peribronchial and perivascular areas, and promoted the expansive growth of microorganisms in the alveoli and destruction of alveolar structure. The neutralization of endogenous IFN-gamma by mAb increased the number of microorganisms in the lung and brain, and significantly shortened the survival time of infected mice. On the other hand, administration of IFN-gamma decreased the number of microorganisms in these organs, and significantly extended their survival time. Considered together, our results suggest that endogenous IFN-gamma protects mice from infection with C. neoformans by inducing a cellular inflammatory response, potentiating the clearance of microorganism from the lungs and preventing its dissemination into the central nervous system.