HLA-DPB1 allele associates with early-onset myasthenia gravis in Japan

We investigated the HLA-DPB1 allele in 43 unrelated Japanese patients with myasthenia gravis (MG) using digestion of polymerase chain reaction (PCR)-amplified DNA with allele-specific restriction endonucleases (PCR-RFLP method). We found a higher frequency of the DPB1*0201 allele in female patients whose ages at onset were less than 30 years (83.3%) than in controls (35.6%). The study also included serologic typing of HLA-A, -B, -C, and -DR antigens in 72 patients with MG, and confirmed previous results demonstrating a strong association of HLA-DR53 with early onset of MG in females. These results indicate that both the DPB1*0201 allele and DR53 play key roles in the disease process of MG in early-onset females, and that the genetic background of Japanese females with early-onset MG is different from that of other patients with MG.

Case report: the effect of a Chinese herbal medicine, BG-104 in two HIV positive hemophiliacs

The BG-104, a Chinese herbal medicine, has been reported to restore decreased plasma superoxide scavenging activity. This report showed in vivo effect of BG-104 on two patients with hemophilia A infected with human immunodeficiency virus by infusions of the concentrated Factor VIII. Both patients, showed a peripheral CD4+ T-lymphocytopenia for more than half a year. BG-104 was administered daily and follow-up observations were continued for 3 years. The number of CD4+ T-lymphocytes remained relatively constant during BG-104 treatment without disease progression.

[Hematologic response to low dose natural interferon-alpha in a case of CML with myelo-megakaryoblastic crisis]

A 59-year-old female with splenomegaly was admitted in November, 1989. Her WBC was 7,900/microliters with 51% myeloblasts and 10% megakaryoblasts. Analysis of the surface markers showed that 56.5% were CD13 positive and 66.8% carried platelet GpIIb/IIIa. The Ph1 chromosome was 100% positive. VPM therapy was started but proved ineffective, as was subsequent MCNU therapy. The patient was given intramuscular human lymphoblastoid interferon-alpha (1.2 million IU daily) for more than 20 months. She had improved to the accelerated phase after INF-alpha therapy for 13 months. Thus there appears to be a relationship between INF-alpha and myelo-megakaryoblastic crisis.

Molecular analysis of abnormal satellite I DNA from a BUF/Mna rat thymoma

BUF/Mna rats develop spontaneous thymomas in an autosomal dominant manner. We constructed recombinant plasmid library of 90 and 185 base-paired (bp) satellite I DNA fragments isolated from BUF/Mna rat thymoma DNA. Four unusual clones containing 93, 95, 95, and 173 bp inserts were isolated by colony hybridization with Wistar rat satellite I DNA. Nucleotide sequence analysis of the inserts of the 4 clones revealed abnormal sequence organization and unusual subunit structure of the rat satellite I DNA. Sequence comparisons between normal and abnormal satellite I DNA suggested that the unusual subunit structure could be generated by the change of the Hinf I recognition sequence to an Eco RI cleavage site, in addition to random deletions, insertions and base substitutions. The heptanucleotide sequence TGGGAAC, which is strictly conserved in normal subunits, was completely lost in all these clones. Southern blot hybridization revealed the amplification of abnormal satellite I DNA in BUF/Mna rat thymomas.

MDR1 (multidrug resistance) gene expression in adult acute leukemia: correlations with blast phenotype

Resistance to multiple chemotherapeutic agents is related to the production of P-glycoprotein, a transmembrane drug efflux pump that is encoded by the multidrug resistance gene (MDR1). To detect low-level or heterogenous expression of the MDR1 gene in acute leukemia, we have developed sensitive, specific and semi-quantitative protocols for measuring levels of MDR1 mRNA, based on the polymerase chain reaction. Using this assay, we screened blasts from 20 patients with untreated adult acute leukemia for evidence of MDR1 gene expression. The level of MDR1 mRNA was normalized to beta 2-microglobulin mRNA and was defined by reference to the highly resistant trimetrexate-selected leukemia cells MOLT-3/TMQ200 (1.80). MDR1 mRNA was observed in 14 out of 20 patients. Higher MDR1 mRNAs were observed in three patients with phenotypes of undifferentiated or minimally differentiated nonlymphocytic acute leukemia, as compared with other types of acute leukemia (0.98 vs. 0.25). In contrast, lower MDR1 mRNAs were found in five patients with acute promyelocytic leukemia, as compared with other types of acute leukemia (0.08 vs. 0.45). These findings suggest that MDR1 gene expression is correlated with the leucocyte differentiation stage of leukemia. MDR1 gene expression may, in part, explain the responsiveness to chemotherapy in these distinct subtypes of acute leukemia.

Acquired chronic pure red cell aplasia successfully treated with intravenous pulse methylprednisolone therapy

A 65-year-old male patient developed acquired chronic pure red cell aplasia (PRCA) associated with hypergammaglobulinemia and positive Coombs' test during the treatment of eosinophilic pneumonia with prednisolone (PSL). His PRCA was treated with oral PSL at a dose of 60 mg/day for 3 weeks, but anemia further progressed. Immediately after high-dose intravenous pulse methylprednisolone therapy (1 g/day for 3 days) however, reticulocyte crisis occurred and his anemia rapidly improved. He has been in complete remission under a maintenance dose of PSL for more than 2 years. This patient indicates that high-dose intravenous methylprednisolone therapy is one of the useful treatments, not only for constitutional PRCA, but also for acquired chronic PRCA.

Essential thrombocythemia developing into refractory anemia and complicated by acute myeloid leukemia

We report a case of essential thrombocythemia (ET) that climaxed in acute myeloid leukemia after developing into refractory anemia. The male patient had ET that was stable for 8 years on carboquone therapy. However, at the age of 72 years he developed an acute terminal illness that was characterized by severe pancytopenia, circulating myeloblasts, extensive bone marrow infiltration by myeloblasts, and an abnormal karyotype [46, XY, t(8q-; 20q+)]. He subsequently died of severe bilateral pneumonia and heart failure. This case suggests that ET may be similar to polycythemia vera; progression to leukemia is unusual except after chemotherapy. Therefore, treatment of patients with asymptomatic ET may not be advisable.

Time course of superoxide generation by leukocytes--the MCLA chemiluminescence system

This study was performed to examine the pattern of superoxide (O2-.) generation from leukocytes using the O2-. specific chemiluminescence (CL) method. Cypridina luciferin analog, 2-methyl-6-(p-methoxyphenyl)-3,7-dihydroimidazo [1,2-alpha]pyrazin-3-one (MCLA) was used as a CL probe. The appropriate conditions of the MCLA method was first determined for the evaluation of the time course of O2-. generation by leukocytes. The time course of O2-. generation obtained by the MCLA-CL system was compared with that by the luminol-dependent CL, electron spin resonance (ESR)/spin trapping, and cytochrome c systems. Following stimulation by three different stimulants (PMA, OZ, FMLP), leukocytes continuously generated O2-. for up to 5 h in the MCLA-CL system, irrespective of the kind of stimulation. The curves obtained by generation ceased more rapidly in the luminol-CL, ESR/spin trapping, and cytochrome c systems. A 50% activity of the initial value was observed at 70 min in the MCLA-CL system, but 30, 10 and 35 min in the other systems, respectively. The CL or O2-. generation value decreased to less than 1% (possible termination) at 300, 90, 120 and 180 min, respectively. With the exception of ESR studies with OZ, the cell viability was not significantly affected in any of the trials. These results indicate that leukocytes can generate O2-. much longer than previously estimated and that the MCLA-CL-system is the most suitable system for the measurement of the O2-. generation by leukocytes.

Differential effects of IL-3, GM-CSF and G-CSF in an adult with congenital neutropenia

Using a methylcellulose culture system, we studied the effects of recombinant human interleukin-3 (IL-3), recombinant human granulocyte-macrophage colony-stimulating factor (GM-CSF), and recombinant human granulocyte colony-stimulating factor (G-CSF) on the growth of myeloid progenitor cells (CFU-C) from an adult patient with congenital neutropenia. The moderate clinical course and the maturation arrest at blast-promyelocyte stage in the marrow differentiated this patient from those described as having Kostmann-type congenital neutropenia. CFU-C growth in bone marrow cells from the patient responded to IL-3 normally in a dose-dependent manner. GM-CSF stimulated only macrophage colony formation in a dose-dependent manner comparable to that in normal subjects. Neither GM-CSF nor G-CSF stimulated any significant granulocyte colony formation. This evidence suggests that the hematopoietic progenitor cells in this patient had the potential for developing CFU-C with IL-3, and that the neutropenia in this patient could be a result of an intrinsic defect in myelopoiesis along a granulocytic pathway responsive to GM-CSF or G-CSF.

Accessory molecules expressed on the peripheral blood or synovial fluid T lymphocytes from patients with Sjögren's syndrome or rheumatoid arthritis

We previously demonstrated that the cells expressed by activation antigens were increased in several T cell subsets from the peripheral blood (PB) and joint fluid (JF) of patients with Sjögren's syndrome (SS) or rheumatoid arthritis (RA). In the present report, we further determined by three-color flow cytometry the homing receptors (Leu8) for peripheral lymph nodes expressed on naive (CD45RA+) or memory (CD45RA-) CD4+ cells and on the two subsets of CD8+ cells (CD11b+ and CD11b-) in the PB and JF from SS and RA patients. In addition, the activation antigens (HLA-DR) and two adhesion molecules, including the alpha-chain of the leukocyte function associated antigen-1 (LFA 1 alpha: CD11a) and its ligand (intercellular adhesion molecule-1: ICAM-1: CD54) expressed on T cells, were compared. We found that CD45RA-CD4+ cells were markedly increased in JF, while CD45RA+CD4+ cells were almost absent. Leu8+ cells were decreased in both CD45RA-CD4+ and CD8+CD11b-cells (cytotoxic T cells) in the JF, and were also decreased in the CD8+CD11b-subset in the patients' PB. Furthermore, activated (DR+) T cells were markedly increased in JF, and the cells expressed more adhesion molecules in both the PB and JF from patients, compared with the DR-T cells. The DR+ T cells therefore are considered to be memory T cells, which are more efficient for cell-to-cell interactions. These observations also suggest that the Leu8- and DR+ T cells with increased adhesion molecules might preferentially migrate into inflammatory tissues, and that naive T cells are being further converted to to memory T cells by in vivo stimulation within the tissues.

Cardiac tamponade in the blastic crisis of chronic myelogenous leukemia

A 36-year-old man with Philadelphia chromosome-positive chronic myelogenous leukemia (CML) developed hemorrhagic pericarditis with tamponade as a terminal manifestation of the blastic crisis. Cardiac tamponade should be kept in mind as an uncommon cause of death of CML patients. Based on a literature review, symptomatic pericarditis in patients with CML blast crisis suggests imminent death. This is in contrast to long-term survival for patients in the chronic phase.

Thymic carcinoma associated with pinealoma and terminating with peroxidase-negative acute myeloid leukemia

Thymoma is associated with a wide variety of syndromes. However, an association with peroxidase-negative acute myeloid leukemia and pinealoma, although feasible due to the marked influence of this tumor on the lymphoid system, has not been described previously. A patient with thymic carcinoma and pinealoma who developed peroxidase-negative acute myeloid leukemia as a late event is presented in this report.

Cell surface antigens expressed on polymorphonuclear cells in the peripheral blood from patients with inflammatory rheumatic diseases: two-color flow-cytometric analysis

Cell surface antigens, such as CR3, Fc gamma RIII, cALLa and Leu 8 antigen, expressed on polymorphonuclear cells (PMN) in the peripheral blood (PB) are associated with certain functions of PMN. Functional alterations of PMN have been reported in some rheumatic diseases. In this study, therefore, the cell surface antigens were examined by 2-color flow-cytometry using monoclonal antibodies to clarify whether expressions of the antigens on PMN are abnormal in patients with rheumatic diseases including Behçet's disease (BD), rheumatoid arthritis (RA) and Sjögren's syndrome (SS). We found that expressions of CR3 and cALLa were increased on PB-PMN from patients with BD or RA, but not from those with SS. In BD, we further determined the phagocytic activity of PMN by a flow-cytometric method using fluorescent particles. The phagocytic activity was significantly higher in BD patients than in healthy controls, and correlated slightly with the expression of CR3 on PMN in the patients. In addition, prednisolone or colchicine seemed to decrease the expression of CR3 and/or cALLa in patients. The above results indicated that PB-PMN in BD and RA, but not SS, are phenotypically activated in vivo, and the activation probably reflects several cytokines and/or other stimuli to PMN produced in the inflammatory process.

Lack of deletion of complement C4 and steroid 21-hydroxylase genes in Japanese patients with primary Sjögren's syndrome

A null allele at C4A (C4AQO) is associated with primary Sjögren's syndrome (SS) in Japanese. Since a deletion of the C4A and CyP21A genes is reported to account for C4AQO in patients with systemic lupus erythematosus (SLE) in Caucasians, we studied the restriction fragment length polymorphism (RFLP) of genomic DNA to determine whether similar deletions of the C4A and CyP21A genes occur in Japanese patients with SS. Patients with C4AQO did not show the extensive deletion of C4A and CyP21A, which would be recognized by the appearance of 8.5 kb/HindIII and 6.4 kb/TaqI fragments hybridizing with a C4 probe. It is yet to be shown whether the lack of expression of C4A genes in Japanese patients with primary SS is due to point mutations, or to small deletions or insertions that were not detected by the RFLP approach.

Serum apolipoprotein H levels in systemic lupus erythematosus are not influenced by antiphospholipid antibodies

Anticardiolipin antibodies (aCL) were recently discovered to recognize a complex consisting of phospholipids and apolipoprotein H (apo H). In this study, we determined the serum apo H levels in 36 systemic lupus erythematosus (SLE) patients with or without antiphospholipid antibodies (aPL), including aCL and lupus anticoagulants, to clarify the possible effects of aPL on apo H levels in vivo. The apo H levels were low in SLE patients as compared with 22 healthy controls. However, no associations were found between apo H levels and circulating aPL or clinical features of the antiphospholipid antibody syndrome. A secondary hyperlipidemic state, which probably related to lupus nephritis (proteinuria) and/or prednisolone treatment, increased apo H levels in SLE patients.

Plasma free catecholamine level during hemopurification in a case of pheochromocytoma

To examine the alteration of the plasma free-catecholamine level during hemopurification in a patient with pheochromocytoma, the levels of plasma free-catecholamine and total catecholamine in the filtrate were monitored pre- and post-hemopurification. Approximately 100 micrograms of total catecholamine was removed by the hemopurification procedure though the high level of plasma-free catecholamine remained unaltered.

Two-color flow cytometric analysis of thymic lymphocytes from patients with myasthenia gravis and/or thymoma

Phenotypic characteristics of lymphocyte components of the thymus were determined by two-color flow cytometry using monoclonal antibodies to T cell-differentiation antigens and activation antigens, and B cells in eight myasthenia gravis (MG) thymuses and eight thymomas including four associated with MG to clarify the roles of thymus in the diseases. Fifteen normal thymuses and four thymuses from non-MG patients were used as controls. Phenotypes of lymphoid components in thymoma resembled those in normal thymuses, in which the majority of lymphoid cells were immature (common) thymocytes (CD4+CD8+ or CD1+CD3-). The proportions of immature thymocytes, however, were relatively higher and those of mature thymocytes (CD4+CD8-, CD4-CD8+, CD1-CD3+ or CD2+CD3+) were lower in thymomas than normal thymuses. The results speculate that functions which support further differentiations of immature thymocytes into mature thymocytes are deficient in neoplastic epithelial cells of thymoma. In thymomas, therefore, occasional T cells might escape from the thymic surveillance system which eliminates auto-reactive T cells. Between thymomas associated with MG and those without, however, no significant difference was found in the proportions of thymocytes at various stages of maturation. In nonthymomatous thymuses from MG patients, an increase of both B cells (CD2-DR+ or CD2-CD21+) and activated T cells (CD2+DR+ or CD2+IL-2R+) was observed. Furthermore, immature thymocytes were significantly decreased and mature thymocytes were increased in the MG thymuses, as compared with normal thymuses, non-MG thymuses, and thymomas. These alterations were relevant to the histological findings observed in MG thymuses such as thymic involutions and germinal center formations: decreased immature thymocytes are considered to reflect thymic involutions, while germinal centers, in which lymphocytes from peripheral lymphoid organs are activated, are responsible for the increase of B cells, activated T cells, and mature T cells. In conclusions, our results suggest that neoplastic epithelial cells of thymomas are functionally deficient and that MG thymuses are immunologically active and resemble peripheral lymphoid organs.

Decreased plasma superoxide scavenging activity in immunological disorders--carboxyethylgermanium sesquioxide (Ge-132) as a promoter of prednisolone

We investigated so-called superoxide scavenging activity (SSA) of plasma in patients with several immunological disorders, such as rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), polymyo-dermatomyositis (PM), progressive systemic sclerosis (PSS), myasthenia gravis (MG) and autoimmune thyroid disease (AT), using the electron paramagnetic resonance/spin trapping technique. Since carboxyethylgermanium sesquioxide, Ge-132, has been reported to modulate both the immune response and leukocyte functions, we have studied in vivo effect of Ge-132 on plasma SSA and other laboratory parameters in these disorders. The plasma SSA was significantly lower in RA, SLE, PM and PSS, but not in MG and AT, as compared with that in healthy controls. An inverse correlation was observed between plasma SSA and parameters such as erythrocytes sedimentation rates, absolute number of leukocytes, C-reactive protein and serum globulin levels. Furthermore, plasma SSA was significantly decreased in rheumatoid factor-positive patients as compared to negative patients. No correlation was observed between plasma SSA and factors such as ages, sex of patients or the other laboratory parameters, such as serum albumin, triglyceride, cholesterol, hemoglobin and serum iron levels. Patients treated with prednisolone, especially ones with RA, showed an increase of plasma SSA. It appears that Ge-132 promotes prednisolone effects. Our results indicate that a decrease in plasma SSA is not disease specific, but inversely correlates with the severity and activity of inflammation. The methodology to measure plasma SSA presented in this work provides a helpful tool for determining the actual activity of the diseases as well as in vivo studies of antiinflammatory agents.

[Recurrent case of subacute necrotizing lymphadenitis in young man]

A 10-year-old male was admitted to our hospital because of lymphadenopathy and fever. Biopsy of a cervical lymph node demonstrated nodular necrotic foci containing many macrophages phagocyting the karyorrhexic nuclei. He was diagnosed as subacute necrotizing lymphadenitis (SNL) and all the symptoms disappeared spontaneously within a month. Five year later, lymphadenopathy recurred, and re-biopsy showed the same histological findings and he also recovered spontaneously. Although the prognosis of SNL is generally excellent and the majority of the patients recover without any treatment, recurrences are very rare, especially in young male patient.

[Clinical study of miconazole on deep-seated fungal infections]

An investigation was made on the efficacy and the safety of miconazole (MCZ) in the treatment of deep seated mycosis. The drug was administered through intravenous drip infusion at dose levels of 800 to 2,000 mg/day to 21 cases of confirmed mycosis for which causative organisms was identified and to 32 cases to which other antibiotics considered to be appropriate had been administered at febrile stages but had failed to take effect, hence mycoses were strongly suspected. The overall clinical efficacy rate was 84.3% (43/51). Treatments were "remarkably effective" in 6 cases, "effective" in 37, "not effective" in 8 and "indeterminable" in 2. The efficacy rates were 100% (21/21) in the confirmed mycosis cases and 73.3% (22/30) in the suspected mycosis cases. The mycological efficacies in the cases for which causative strains were identified were: disappeared in 14 (66.7%), decreased in 4 (19%), unchanged in 2 (9.5%) and unknown in 1 (4.8%), thus the overall disappearance ratio was 70% (14/20). Chest X-ray showed the disappearance of shadow in 1 patient and improvements in 14 of 23 patients examined. Adverse reactions were observed in 5 of the 53 cases (9.4%). From these results, MCZ may be considered as a highly useful drug not only in the treatment of deep mycosis but also in cases for which mycosis is strongly suspected.

"Yellow nail syndrome" and rheumatoid arthritis

A nail dystrophy characterized by the slow growth of nails and their yellowish discoloration, the so-called yellow nail syndrome (YNS), has been associated with various conditions including rheumatoid arthritis (RA). We reviewed the histories of RA patients reported in the literature and our own cases. Most of the RA patients with YNS had been treated with the anti-rheumatic agents D-penicillamine and bucillamine. In non-treated patients, spontaneous YNS was very rare. However, pulmonary diseases, edema and other systemic complications were frequently observed in both drug-induced and spontaneous YNS associated with RA. Although the nail changes and systemic complications are probably due to different causes in drug-induced YNS, a careful search for systemic complications are necessary in patients who develop nail changes. The exact mechanism of nail growth retardation is not understood in patients with YNS, including those with drug-induced YNS. The nail changes in the latter were not associated with deficiencies of inorganic elements in either nails or sera.

T cells bearing gamma/delta T cell receptor and their expression of activation antigen in peripheral blood from patients with Sjögren's syndrome

T cells bearing gamma/delta T cell receptor (gamma/delta + T cells) and their expression of activation antigen (HLA-DR) or the marker of natural killer (NK) cells (CD56), were examined in the peripheral blood lymphocytes (PBL) from twenty-two patients with Sjögren's syndrome (SS) by three-color flowcytometry to elucidate possible pathological roles of the T cell subset in SS. The frequency of gamma/delta + T cells in PBL was not elevated in SS patients, while that of gamma/delta - T cells, which are T cells bearing the alpha/beta T cell receptor (alpha/beta + T cells), was significantly low in the patients, as compared with 22 healthy controls. We found that the proportions of activated cells (HLA-DR+) in both the gamma/delta + and alpha/beta+T cell subsets were significantly higher in the patients than in the controls. The proportions of HLA-DR+ cells in cells in both patients and controls. Furthermore, the frequency of activated cells in both T cell subsets correlated with the duration of disease in SS patients. However, no difference was found in the percentages of total CD56+ cells, CD56+CD3- cells (true NK cells), CD56+CD3+T cells, CD56+gamma/delta+T cells, or CD56-gamma/delta+T cells between the patients and controls. The above results indicate that immunologic activation in SS patients is progressive and involves both alpha/beta+ and gamma/delta+ T cell subsets.

BG-104 enhances the decreased plasma superoxide scavenging activity in patients with Behçet's disease, Sjögren's syndrome or hematological malignancy

BG-104, a compound of Chinese herbs, has been reported to exert superoxide scavenging activity (SSA) in cell free systems. This report addresses in vivo effects of BG-104 in various disorders. The plasma SSA and laboratory parameters were determined in patients Behçet's disease (BD), Sjögren's syndrome (SjS) or hematological malignancy (M), and the effects of BG-104 treatment on these parameters were studied and compared with those of another antioxidant, vitamin E (alpha-tocopherol). The plasma SSA was significantly lower both in patients with BD and M, and in patients with SjS without antioxidant treatment as compared to that in healthy controls, and it showed an inverse correlation with disease activities. The treatment with BG-104 and/or vitamin E significantly enhanced the plasma SSA in all disorders studied. Both the erythrocyte sedimentation rates, the absolute number of neutrophils, as well as C-reactive protein levels were significantly lower in patients treated with BG-104 and/or vitamin E than those without these drugs. These results indicate that the BG-104 has an anti-inflammatory effect through enhancing plasma SSA in patients with BD, SjS or M.