Clinical features of Japanese children and adolescents with systemic lupus erythematosus: results of 1980-1994 survey

Marked advances have been made in the past decade in the management of adults with systemic lupus erythematosus (SLE). Therefore, a nationwide retrospective survey was conducted between 1980 and 1994 to investigate the clinical manifestations of SLE in Japanese children and adolescents. Questionnaires were sent to 340 hospitals. Of 405 patients reported by 176 hospitals, 373 patients, diagnosed by the criteria established by the Pediatric Study Group of the Japanese Ministry of Health and Welfare in 1985, were enrolled in the study. Forty-nine of the 354 patients (13.8%) had relatives with a connective tissue disease within the third degree of consanguinity. The frequent manifestations in 373 patients were the presence of antinuclear antibody (98.9%), immunologic disorders (93.0%), hypocomplementemia (87.1%), malar rash (79.6%) and fever (74.0%). Lupus nephritis was present in 148 of the 309 patients (47.9%) at their first visit to a clinic, and 261 of the 373 patients (70.0%) developed renal involvement during the observation period. Of 370 patients, 92 patients (24.9%) exhibited central nervous system lupus. Of 368 patients, 192 patients (52.2%) were treated by methylprednisolone pulse therapy and 148 patients (40.2%) received immunosuppressants in combination with steroid therapy at some stage during the observation period, Survival rate at 5 years from onset was 95.9%. Management of infection, coagulopathies, and central nervous system involvement is essential to improve the prognosis of SLE in Japanese children and adolescents.

B cell epitope mapping of the bacterial superantigen staphylococcal enterotoxin B: the dominant epitope region recognized by intravenous IgG

We showed that i.v. IgG contains Abs against a major group of bacterial superantigens, and that they can inhibit superantigen-elicited T cell activation. The B cell epitope region of the superantigen and the inhibitory mechanism have remained unknown. To analyze the dominant B cell epitopes on the bacterial superantigen SEB (staphylococcal enterotoxin B), we constructed fusion proteins of SEB deletion mutants, and the reactivities of these recombinant proteins to i.v. IgG and healthy human sera were evaluated by means of immunoblotting. Intravenous IgG and healthy human sera mostly recognized the C-terminal fragment (amino acid (aa) 133-239). The C-terminally truncated protein (aa 1-228) and the truncated mutant delta 225-234 lost reactivity, while the truncated protein (aa 1-234) did not, suggesting that the region (aa 225-234) is the dominant B cell epitope. The mutant, in which residues 226-229 of SEB were exchanged for residues 209-212 of streptococcal pyrogenic exotoxin A, reduced the reactivity with the C-terminal region-specific IgG purified by affinity chromatography. The C-terminal region-specific IgG inhibited SEB-elicited T cell activation, suggesting that this Ab that recognizes the epitope functions as the humoral defensive factor against SEB in humans. Furthermore, the assumed epitope region was homology to the residues (aa 32-41) of human thymopoietin, containing the biologic active site.

B cell epitope mapping of the bacterial superantigen staphylococcal enterotoxin B: the dominant epitope region recognized by intravenous IgG

We showed that i.v. IgG contains Abs against a major group of bacterial superantigens, and that they can inhibit superantigen-elicited T cell activation. The B cell epitope region of the superantigen and the inhibitory mechanism have remained unknown. To analyze the dominant B cell epitopes on the bacterial superantigen SEB (staphylococcal enterotoxin B), we constructed fusion proteins of SEB deletion mutants, and the reactivities of these recombinant proteins to i.v. IgG and healthy human sera were evaluated by means of immunoblotting. Intravenous IgG and healthy human sera mostly recognized the C-terminal fragment (amino acid (aa) 133-239). The C-terminally truncated protein (aa 1-228) and the truncated mutant delta 225-234 lost reactivity, while the truncated protein (aa 1-234) did not, suggesting that the region (aa 225-234) is the dominant B cell epitope. The mutant, in which residues 226-229 of SEB were exchanged for residues 209-212 of streptococcal pyrogenic exotoxin A, reduced the reactivity with the C-terminal region-specific IgG purified by affinity chromatography. The C-terminal region-specific IgG inhibited SEB-elicited T cell activation, suggesting that this Ab that recognizes the epitope functions as the humoral defensive factor against SEB in humans. Furthermore, the assumed epitope region was homology to the residues (aa 32-41) of human thymopoietin, containing the biologic active site.

Effect of 5-alpha dihydrotestosterone on T-cell proliferation of the female nonobese diabetic mouse

Nonobese diabetic (NOD) mice develop type I diabetes spontaneously and have been utilized as a model for human autoimmune insulin-dependent diabetes. The disease is caused by the destruction of insulin-producing beta cells in the pancreatic islet of Langerhans by infiltrating inflammatory cells, which are primarily T lymphocytes. The incidence of diabetes in NOD mice is increased in females compared with males, suggesting that sex steroid hormones play an important role in the development of the disease. We therefore investigated the effect of a male steroid, 5-alpha-dihydrotestosterone (5DHT), on disease development, T-cell phenotype, T-cell proliferation, and cytokine profiles in this model. None of the mice that received 5DHT for 120 days (n = 7) developed insulitis, whereas all control mice (n = 8) developed the disease. The percentage of CD4+ T cells in peripheral blood mononuclear cells was markedly decreased in the 5DHT-treated females compared with those in controls (37.1 +/- 4.8 vs 51.3 +/- 9.3, P < 0.02), whereas no significant differences in the percentage of CD8+ T cells were observed between treated and control female mice. Results of a syngeneic mixed lymphocyte reaction (SMLR) also suggested that T cells are major target cells of 5DHT administration. An increased expression of IL-4 mRNA, representing T helper 2 (Th2) T cells, was observed in the SMLR. On the basis of these results, a systemic administration of 5DHT appears to have direct effects on the expansion of Th2 cell populations with subsequent restoration of normal immune responses.

Serum levels of hyaluronic acid indicate the severity of joint symptoms in patients with systemic and polyarticular juvenile rheumatoid arthritis

OBJECTIVE

Elevated serum levels of hyaluronic acid (HA) correlate with joint inflammation in adult rheumatoid arthritis (RA). There are no laboratory indices for specifically assessing joint inflammation. Therefore, serial measurements of HA were assessed as a possible tool for measuring the severity of arthritic symptoms in children with juvenile rheumatoid arthritis (JRA).

METHODS

Serum levels of HA, measured by a sandwich assay method using HA binding protein, were correlated with the severity of joint symptoms and with laboratory test values in 71 patients with JRA, 30 children with other rheumatic diseases, and 138 children without rheumatic disease.

RESULTS

Serum levels of HA showed significant correlation with the severity of joint symptoms, but not with systemic symptoms, in patients with systemic and polyarticular JRA. No other laboratory tests, including C-reactive protein and erythrocyte sedimentation rate, reflected the severity of joint symptoms. This correlation of serum levels of HA with joint symptoms was observed in patients with systemic and polyarticular JRA, but not in pauciarticular JRA, other rheumatic diseases, or nonrheumatic diseases, even when signs of arthritis were present in the latter 3 groups.

CONCLUSION

Serum levels of HA are useful in objectively evaluating arthritic symptoms in patients with systemic and polyarticular JRA, and may have diagnostic value in this disease.

Methylation status of 5'-regulatory region of tumor necrosis factor alpha gene correlates with differentiation stages of monocytes

The DNA methylation status of the 5'-regulatory region of human tumor necrosis factor-alpha (TNF-alpha) gene was examined using two human monocytic cell lines representing different differentiation stages: one cell line, THP-1, represents the most differentiated macrophage-like phenotypes and the other, HL-60, represents a least differentiated phenotype. Two restriction enzymes were used to detect methylated sites in the 5'-regulatory region of the TNF-alpha gene. The restriction enzyme Msp I, which recognizes both CCGG (unmethylated) and C(me)CGG (methylated) sequences, whereas Hpa II recognizes only the unmethylated CCGG sequence. Two Msp I sites located at -600 and +200 nucleotides, respectively, from the transcriptional initiation site were unmethylated in DNA from the THP-1, whereas these sites were methylated in the one from the HL-60. Treating the HL-60 cells with 1,25-vitamin D3, ( 1,25-(OH)2D3), which is known to induce monocytic cell differentiation, induce demethylation of the sites, suggesting the methylation status was correlated with the differentiation stages of monocytes.

Mitral regurgitation may be related with previous streptococcal infection

We measured anti M protein antibody (AMPA) titres in children with idiopathic mitral regurgitation (MR), streptococcal infection, rheumatic fever (RF), post-streptococcal acute glomerulonephritis (AGN) and normal healthy children. We investigated the association of MR with streptococcal infection and whether high AMPA titres can be used as persisting evidence of previous streptococcal infection. AMPA titres were measured with an enzyme-linked immunosorbent assay. We found significantly higher antibody titres in patients with MR and in streptococcal infection, RF, and AGN than in healthy controls. In the MR group (n = 15), 54% patients had AMPA titres above the 90th percentile value that was found in normal controls. An elevated AMPA titre persisted for a long period even when the anti-streptolysin O titres had declined to normal in RF patients. Our data suggest that the high AMPA titres in MR should be further investigated to clarify the probable association with previous streptococcal infection.

CONCLUSION

High AMPA titre is a risk factor for developing complications after streptococcal infection. Our serological evidence suggests that in some patients, MR may be related to previous streptococcal infection.

Age-related occurrence of inhibitory antibodies to streptococcal pyrogenic superantigens

Several bacteria, such as staphylococci and streptococci, can produce superantigens (SA) that induce the activation of T cells in humans. Although these organisms are the major causes of infection in children, the evidence that T cells are vigorously activated by SA produced by such organisms has not been reported except for toxic shock syndrome. In a previous paper, we demonstrated that inhibitory IgG antibodies (Ab) to SA in humans may protect against SA stimulation. In the present study, we investigated the occurrence of these inhibitory Ab to SA in 94 healthy children by the enzyme linked immunosorbent assay technique and the suppressive effect on T cell stimulation by SA. The positivity of Ab to streptococcal pyrogenic exotoxin (SPE)-A, SPE-C and staphylococcal enterotoxin B (SEB) increased with age. The age at which more than 50% of children exhibited Ab to SA was 1 year for SEB, 6 years for SPE-C and 11 years for SPE-A. Sera from these children were inhibitory to T cell proliferation elicited by SA in proportion to the concentration of IgG Ab to each SA. Sera supplemented with IgG Ab to SA by gamma-globulin therapy became inhibitory to T cell proliferation by SA. We conclude that, as children grow, they can develop Ab to SA that may play a role in protecting them against vigorous T cell activation by SA.

Changes in En(a-) human red blood cell membranes during in vivo ageing

The human red blood cells with phenotype En(a-) were characterized by the lack of MN antigens. The red blood cells with phenotype En(a-) which were found in a Japanese family were tested to clarify the changes in membrane surfaces of the red blood cells during in vivo ageing. The contents of sialic acid, glucose, mannose, galactose, fucose, N-acetylglucosamine and N-acetylgalactosamine of the red blood cell membranes obtained from the old red blood cells with phenotype En(a-) were significantly lower than those of the young red blood cell membranes. Neither the young nor the old red blood cells with phenotype En(a-) showed the agglutination with Arachis hypogaea (PNA) which was capable of binding to T agglutinogen. It is presumed that En(a-) red blood cells are not exposed to sialidase in vivo. In comparison with the young En(a-) red blood cell membranes, the number and the distribution density of lectin receptor sites on the old ones for Limulus polyphemus (LPA), Canavalia ensiformis (Con A), Triticum vulgaris (WGA) and Bauhinia purpurea (BPA) were significantly lower. It is thought that En(a-) red blood cell ageing is accompanied by elimination of some sialoglycoconjugates which have affinity for LPA, Con A, WGA and BPA, whereas En(a-) red blood cells lack glycophorin A.

Acute rheumatic fever and poststreptococcal acute glomerulonephritis caused by T serotype 12 Streptococcus

We present a rare case of a 10 year old Japanese boy with acute rheumatic fever accompanied with poststreptococcal acute glomerulonephritis. We isolated group A Streptococcus serotype T 12, a strain that was thought to be nephritogenic but not rheumatogenic, from throat culture. Although rare, physicians should be aware that acute renal disease may accompany rheumatic fever.

[Augmentation of clonidine on Bezold-Jarisch reflex control of renal sympathetic nerve activity in cats]

The present study was undertaken to examine the possible augmentation of clonidine on the control of renal sympathetic nerve activity by Bezold-Jarisch reflex in anesthetized cats. Veratrine (3-20 micrograms/kg) produced dose-dependent decreases in arterial blood pressure (BP), heart rate (HR) and renal sympathetic nerve activity (RNA). Clonidine (3 micrograms/kg) resulted in decreases in BP, HR and RNA. Clonidine significantly potentiated the influence of Bezold-Jarisch reflex on RNA, but did not potentiate the influence of Bezold-Jarisch reflex on BP and HR. Bezold-Jarisch reflex gain calculated as percent inhibition of renal sympathetic nerve activity divided by decreases in mean blood pressure was significantly higher after the administration of clonidine.

Glipizide-induced prevention of diabetes and autoimmune events in the BB rat

To determine whether glipizide, a sulfonylurea, can prevent diabetes in the diabetic-prone BB rat model, rats were studied from 35 to 240 days of age. Treated animals received oral glipizide (10 or 100 mg/kg/day) from 35 to 200 days of age, and control rats received oral placebo. From 80 to 135 days of age at both drug doses, glipizide decreased the incidence of diabetes, thus delaying disease onset (P < 0.02). At the higher dose of glipizide, a diabetes preventive effect was observed (P < 0.025). There were no significant differences in body weights between the treated and control groups. At 240 days, i.e. 40 days after stopping glipizide and placebo treatments, diabetes incidence remained stable in the two groups; thus the effect of glipizide persisted after discontinuation of the drug. Serum glucose and insulin levels measured at 90 and 200 days did not reveal differences between the glipizide treated and control groups. To determine whether the sulfonylurea affected autoimmune events, the prevalence and severity of islet inflammation were examined. In glipizide-treated BB rats at 240 days, only 44% of rats had islet inflammation compared to 86% in the control group (P < 0.01). At both 90 and 240 days the severity of islet inflammation was decreased in the glipizide treatment groups compared with the control groups (P < 0.01). These data indicate that glipizide (a) prevents diabetes in the diabetic-prone BB rat strain, (b) decreases the prevalence and severity of islet inflammation even after drug withdrawal and (c) may dampen autoimmune events leading to diabetes onset.

[Clinical features of infantile patient with juvenile rheumatoid arthritis]

Little is known about clinical features of infantile juvenile rheumatoid arthritis (JRA) because it is very rare for the patients to develop JRA within one year of age. In the past 20 years, we experienced three JRA patients whose onset was under 1 year of age. The incidence of infantile JRA was 3.2% of all JRA patients in our facility. They are 9 month-old male with systemic onset, 6-month-old female with polyarticular onset and 8 month-old female with systemic onset. It was difficult to evaluate subjective symptoms such as arthralgia or morning stiffness since the patients could not complain precisely. Therefore, careful observation on their behaviors, such as the delayed development of their motor function and bad humor and/or loss of activity in the morning, was important for evaluating joint symptoms. In case 1, measuring the serum level of hyaluronic acid was specifically useful to evaluate the arthritis. Drug therapy was not successful especially in infantile JRA. One of the reason for this ineffectiveness of drug therapy might be explained by poor adsorption of drugs in infants; the serum acetyl salicylic acid level was lower in infantile patients than the other patients with JRA even though they received enough dose of aspirin. Infantile JRA was revealed to have specific difficulties in early diagnosis and adequate treatment. Therefore, accumulated case studies about clinical features of infantile JRA is essential for their better prognosis.

In situ islet cytokine gene expression during development of type I diabetes in the non-obese diabetic mouse

Expression of cytokine genes in the islets of non-obese diabetic (NOD) female mice was examined. RNA samples were prepared from the islets and spleens of NOD mice at different time points at prediabetic stages during the natural disease process. Cytofluorometric analyses showed that the majority of lymphocyte infiltrates in the islets at 14 weeks of age consisted of T cells (68%). Of these, 80% of Thy1.2+ cells were CD4+ T cells. Less than 1% of in situ islet immune cells expressed a cell surface marker specific for the macrophage (Mac-1). Results of polymerase chain reaction using RNA (RT-PCR) prepared from spleens, and isolated and purified islets demonstrated that IFN-gamma message was detectable in the islets at 7 weeks of age (an early stage of insulitis). No message for this gene was detected in the spleen at any stage studied (7, 14 and 16 weeks of age). In contrast, TNF-alpha message was detected in both spleen and the islets at all stages, although the level of expression of TNF-alpha in the islets was much higher than that in the spleen. These results suggest that both cytokines are produced by in situ islet T cells, possibly activated T cells, which may be responsible for initiating or perpetuating autoimmune reactions in the islets.

Isolation and function of human and pig islets

This report confirms reproducible methods to isolate and assess viability and function of pig and human islets. We processed 10 pig and five human pancreata. The pancreata were digested by a modification of Ricordi's automated method for islet isolation. The number of islet equivalents (150 microns diameter islets) was 335,190 +/- 79,345 islets per pig pancreas (5,146 +/- 1,274 islets/g pig pancreas) and 323,630 +/- 147,810 per human pancreas (6,252 +/- 2,572 islets/g human pancreas). The majority of islets were in the range of 50-200 microns diameter, and 20% of the islet population had a size distribution of 200 microns diameter in both porcine and human models. The purity of the final preparations exceeded 90%. The secretory response of perifused islets showed a biphasic insulin release pattern in both species. Perifused fresh pig islets released 2.5 pmol/L islet-1 min-1 at 2.0 mM glucose and 6.2 pmol/L islet-1 min-1 at 16.7 mM glucose. After 7 days culture at 37 degrees C, human islets released 1.32 pmol/L islet-1 min-1 at 2.0 mM and 12.24 pmol/L islet-1 min-1 at 16.7 mM. These results indicate that this procedure is useful to obtain pure, large, and functional islets from pig and human pancreata.

Weak N activity of En(a-) human erythrocyte membranes

The propositus's erythrocytes with phenotype En(a-), which was found for the first time in a Japanese family, reacted more weakly with anti-N serum than the ordinary phenotype N erythrocytes. The En(a-) erythrocytes lack the major membrane sialoglycoprotein (glycophorin A) as demonstrated by Bio-Gel 1.5m gel filtration from active sialoglycoproteins, which were isolated from En(a-) erythrocyte membranes by the method of lithium diiodosalicylate (LIS)-phenol extraction. It is suggested from observation via enzyme-linked immunosorbent assay (ELISA) that N activity is derived from the glycophorin B molecule on En(a-) erythrocyte membranes.

Quantitative phenotypic and functional analyses of islet immune cells before and after diabetes onset in the BB rat

Inflammatory cells invading islets are thought to be mediators of islet destruction in spontaneous autoimmune diabetes mellitus. Thus methods were developed to isolate and characterize in situ islet inflammatory cells from 75-95-day-old prediabetic and diabetic BB rats. Islet inflammatory cells were structurally examined using single- and double-colour flow cytometry. Functional studies consisted of cytolytic assays using normal rat islet target cells and in situ islet or spleen effector cells. Structural data reveal natural killer cells to be the major cell population (70%) of total immune cells present in inflamed islets during prediabetes. At diabetes onset, the natural killer cell population remained at a high level (47%), but an increasing population of T cells (40%) was noted also. Analyses of T-cell subsets before and after diabetes onset revealed CD4+ T cells as predominant (50-55% of total T cells) with double-negative (CD4-CD8-) T cells (25-30%) and CD8+ T cells (15-20%) also present in significant quantities. Activated T cells accounted only for a minority of T cells (< 3%). Functional studies indicate that in situ islet-derived cytolytic effector cells are more potent killers (ten-fold) of normal islet target cells than are splenic effector cells. These data suggest that in situ islet inflammatory cells (a) can be quantitatively studied both structurally and functionally; (b) express structural phenotypes differing substantially from splenic mononuclear cell populations; (c) are considerably more cytolytic than splenic effectors; and (d) should prove informative in determining the most significant autoimmune functional events prior to and during islet beta-cell destruction.

Quality of life and daily management of children with rheumatic disease

Appropriate management of the daily life of patients with rheumatic diseases is an important part of therapy for favorable results and a high quality of life. At home, gymnastic exercise, night splints and appropriate fun activities will help to preserve the function of affected joints of patients with juvenile rheumatoid arthritis (JRA). Improvement of home fixtures according to patient disability will provide a higher quality of life for the patients. The patient should be helped to perform as many school activities as would normally be possible. Instructional charts for management of school life for patients with JRA and systemic lupus erythematosus is shown in this article. Cooperation with school personnel is also crucial to support the patient emotionally and physiologically. For the best long-term treatment and a good relationship between patient and physician, comprehensive management is essential. Not only physicians, but also psychiatrists, occupational therapists, physical therapists and social workers should be involved in the treatment of children with rheumatic diseases.

Pancreatic islet function in nondiabetic and diabetic BB rats

A decreased acute insulin response to glucose in islet cell antibody positive humans predicts diabetes. Because the dominant mechanism leading to decreased in vivo acute insulin response to glucose remains unclear, perifused islets were examined before and after diabetes onset in BB rats to assess the role of glucose sensitivity on insulin secretion in individual islets. Islets from normal WF rats, diabetes-prone rats without inflamed islets, diabetes-prone rats with inflamed islets, and diabetic rats were studied at 2.0, 8.3, and 16.7 mM glucose. Immunoreactive insulin from WF islets at 16.7 mM glucose was 0.15 +/- 0.02 ng.0-7 min-1 x islet-1 for the first phase and 1.00 +/- 0.05 ng.7-20 min-1 x islet-1 for the second phase of biphasic secretion, compared with basal secretion of 0.10 +/- 0.03 ng.20 min-1 x islet-1 at 2 mM glucose. Diabetes-prone noninflamed islets showed a 0.20 +/- 0.03 ng first-phase secretion, a 1.32 +/- 0.13 ng second-phase secretion after 16.7 mM glucose, and 0.093 +/- 0.02 ng.20 min-1 x islet-1 at 2 mM glucose, indicating no intrinsic BB rat strain secretion abnormality. Diabetes-prone inflamed islets had secretions of 0.35 +/- 0.02 ng during the first phase (P < 0.05 vs. WF) and 1.78 +/- 0.29 ng during the second phase (P < 0.05 vs. WF) after 16.7 mM glucose, with 0.24 +/- 0.08 ng.20 min-1 x islet-1 at 2 mM glucose.(ABSTRACT TRUNCATED AT 250 WORDS)

Intravenous immunoglobulin contains specific antibodies inhibitory to activation of T cells by staphylococcal toxin superantigens [see comment]

Superantigens are products of bacteria with dual affinity for HLA-DR and the variable region of the beta chain of the T cell receptor, leading to the stimulation of large numbers of T cells. Because there is evidence for the involvement of superantigens in various disease conditions in which intravenous IgG (IVIgG) is used as therapy, the purpose of the present study was to determine if IVIgG contains antibodies inhibitory to T cell stimulation by the superantigens. ELISA and Western assays revealed high concentrations of antibodies in the pooled IgG against eight different staphylococcal toxin (Staph-toxin) superantigens. The IVIgG inhibited in vitro stimulation of human peripheral blood T cells by the Staph-toxins, but did not inhibit responses elicited by phytohemagglutinin or anti-CD3. Inhibition was mediated by Staph-toxin-specific antibodies as shown by affinity adsorption depletion studies. The antibodies functioned by inhibiting the binding and/or presentation of Staph-toxins by DR+ accessory cells. In conclusion, this report is the first to show that normal pooled IgG contains antibodies against a major group of the superantigens, the Staph-toxins, and that the antibodies can inhibit Staph-toxin-elicited T cell activation, suggesting a possible immunoregulatory role for the antibodies in vivo.

Serological and biochemical studies on En(a-) human erythrocytes in a Japanese family

The propositus erythrocytes with phenotype En(a-), which was found in the first example of a Japanese family, reacted with anti-N serum weaker than the ordinary phenotype N erythrocytes. When the erythrocyte membranes of the propositus were subjected to SDS-PAGE, no glycophorin A was observed on the gel by PAS staining, whereas glycophorin B band was observed. The S and the s antigens of the propositus erythrocytes were appeared to be normal. These results suggested that N activity of the propositus erythrocytes may be derived from glycophorin B components on the erythrocyte membranes. The amounts of bound sialic acid of the erythrocyte membranes were significantly lower in the En(a-) erythrocytes than the ordinary OMN erythrocytes. Neither the OMN nor the En(a-) erythrocytes showed the agglutinability to Arachis hypogaea lectin. The number of lectin receptor sites on the En(a-) erythrocyte membranes was significantly lower than on the OMN erythrocyte membranes for Limulus polyphemus, Triticum vurgaris and Bauhinia purpurea lectins. These results provide further support for the contention that En(a-) cells lack the glycophorin A as major erythrocytes sialoglycoprotein on the membranes.

[Complex chromosome aberrations between no. 17 and no. 21 in acute myelo-megakaryocytic leukemia: a case report]

A 10 month-old boy presented with fever. He was diagnosed as having acute myelo-megakaryocytic leukemia by electron microscopic cytochemical examination. In spite of aggressive chemotherapy, complete remission could not be achieved and he died seventeen months after the diagnosis was made. G-band karyotypes of the bone marrow cells revealed 45, XY, -17, -21, + dir tan dup (17;21) (17pter----cen----17q25::17q21----17q25;21q11 ----21qter). Furthermore, the same chromosomal aberrations were detected in the cells which were tetraploid and octaploid. Although, neoplastic changes in the progenitor cells immediately before differentiating to CFU-Meg and CFU-GM, are suggested there is a possibility of clonal evolution.

Quantitative and functional analyses of spleen and in situ islet immune cells before and after diabetes onset in the NOD mouse

Cytofluorometric analysis using specific monoclonal antibodies directed against the T cell antigens Thy-1.2, CD4, CD8, CD4V beta(8.1 + 8.2 + 8.3), and the antigen Mac-1 expressed by mature macrophages and NK cells were used to characterize and quantify the phenotypes of (1) unfractionated and Percoll gradient fractionated in situ islet immune cells isolated from prediabetic and diabetic female NOD mouse spleens. We found in prediabetic female mice that the majority (approximately 70%) of the in situ islet immune cells were Thy-1.2 positive T cells. CD4 positive T cells (approximately 40%) were the most abundant phenotype together with double negative T cells (approximately 20%). The percentage of CD8 positive T cells were approximately 10%, and only approximately 4% of the immune cells were Mac-1 positive. The percentages of CD4V beta (8.1 + 8.2 + 8.3) positive and double negative T cells in diabetic spleens were significantly higher in comparison to prediabetic spleens. In C57B1/6J control nondiabetic mice the percentage of double negative T cells in the spleens was significantly 4-fold lower when compared to diabetic NOD spleens. The specific cytolytic activity mediated by in situ islet immune cells against 51Cr-labeled dispersed syngeneic single-cell islet cells at an effector to target ratio of 20 was twenty- to thirty-fold higher than that mediated by prediabetic splenic lymphoid cells. It is concluded that prediabetic NOD mouse in situ islet immune cells are mostly CD4 positive and double negative T cells, and that CD4 and CD8 positive T cells in the intra-islet infiltrate warrants further evaluation as potential effector T cells in target beta-cell destruction.

[A case of mediastinal cavernous hemangioma]

A case of mediastinal cavernous hemangioma was reported. An asymptomatic 6-year-old girl was discovered to have a mass in the left anterior superior mediastinum on a routine chest x-ray film. Computed tomograms demonstrated a mediastinal mass with calcification. Under a median sternotomy, a 10 x 9 x 5 cm mass was resected after dissecting the connections to the pericardium. As the mass surrounded the left phrenic nerve, the nerve was resected with the tumor. The histopathology was cavernous hemangioma. The calcification was not found in the vessels as the phleboliths but was showed in the interstitial tissues.

[A case report of anomalous left brachiocephalic vein]

An anomalous case of a left brachiocephalic vein passing behind the ascending aorta was observed in a 49-year Japanese man. This is known as anomalous left brachiocephalic vein. The anomalous left brachiocephalic vein descended along the left mediastinum in a position identical to that of a persistent left superior vena cava, so the diagnosis of this venous abnormally require carefully considered. Many cases of anomalous left brachiocephalic vein have been reported based on autopsy findings, but this venous anomaly was recently demonstrated by ultrasonography, CT, and MRI.

[A case of tuberculous lymphadenitis diagnosed by the open abdominal lymph node biopsy]

A 16-year-old female was admitted to our hospital six months ago. On X-ray examination of the test, swelling of lymph nodes in the right mediastinum was seen. CT scan showed multiple lymph node swelling in the neck, mediastinum and abdomen. On open abdominal lymph node biopsy, she was diagnosed as tuberculous lymphadenitis and liver tuberculosis. Antituberculous chemotherapy consisting of INH, RFP, EB and SM was started. After regular treatment, right mediastinal lymph nodes were markedly reduced in size on chest X-ray film. At present, she is in fine condition. Surprisingly, her condition has improved to a great extent within six months.

Atropine-resistant relaxation induced by high K+ in iris dilator muscle of the rat and pig

1. The effects of high K+ ion concentration on the isometric tension in dilator muscle strips of the rat and porcine iris were examined. A high K+ solution, prepared by the replacement of Na+ in the medium with equimolar K+, was applied in the presence of 1 microM phentolamine, 1 microM propranolol and 1 or 10 microM atropine. High K+ (greater than 20 mM) induced a biphasic response; an initial phasic contraction followed by relaxation rather than tonic contraction. 2. An additional application of a Ca2+ antagonist, 1 microM nifedipine or nicardipine, almost completely blocked the K(+)-induced initial contraction and enhanced the following relaxation. The effect of K+ under these conditions was concentration-dependent in the range 20 to 80 mM. The maximum amplitude of the atropine-resistant relaxation induced by high K+ corresponds to 50-75% of that produced by acetylcholine in the absence of atropine. A similar K(+)-induced relaxation was observed in the porcine iris dilator. 3. The atropine-resistant relaxation in the rat iris dilator was not affected by pretreatment with 10 microM ouabain. The relaxation induced by 40 or 80 mM K+ in the porcine dilator was slightly enhanced or not affected, respectively, in the presence of 1 microM ouabain. Application of 10 microM ouabain per se induced relaxation in the porcine iris dilator. 4. The low Na+ ion concentration present in high K+ solutions was not responsible for the K(+)-induced relaxation since the complete replacement of Na in the medium with Tris did not affect significantly the relaxation produced by high K(+)-containing solutions. 5. Neither 1 microM tetrodotoxin, 10 microM indomethacin, 10 JM nordihydroguaiaretic acid nor hypoxic conditions affected the high K+-induced relaxation. 6. The inherent tone of the rat iris dilator was not affected by either 8-bromo cyclic GMP, dibutyryl cyclic GMP (0.1-0.3 mM) or nitroprusside (1-100 microM). 7. These results may suggest that the atropine-resistant relaxation induced by high K+ is not due to either activation of the Na-K pump or release of a relaxing factor produced by oxidative metabolism. Although the relaxation mechanism has not been elucidated, it is probably not mediated by an increase in cellular cyclic GMP levels.

MHC class II molecules (Ia-antigens) on macrophages in BB/W rats

The percentage, absolute number and expression of Ia-antigen of macrophages (Mø) in peripheral blood cells (PBC) and splenocytes from Bio-Breeding/Worcester (BB/W) rats were evaluated. The percentage of Mø in PBC and splenocytes from BB/W rats was significantly higher than those in normal Wistar rats from Clea Japan Inc. (NW/C) and Charles River Japan Inc. (NW/CR). The percentage of Ia-positive Mø in PBC and splenocytes from BB/W rats was significantly increased compared with that in NW/C rats. On the other hand, there was no significant difference in the percentage of Ia-positive Mø of PBC between BB/W and NW/CR rats, and the percentage of Ia-positive Mø in the spleen from BB/W rats was significantly lower than those in NW/CR rats. Thus, the quantity of MHC class II molecules on circulating Mø is not related to the pathogenesis of diabetes mellitus in BB/W rats.

Binding of lectins to "young" and "old" human erythrocytes

"Old" human erythrocytes showed a 21.2% decrease in cell surface area and a 2% decrease in the number of WGA receptor sites, but a 27% increase in the distribution density of the WGA (lectin) receptor site, when compared with "young" human erythrocytes. For a list of lectin abbreviations, see Materials and methods). Both "young" and "old" erythrocytes exhibited very weak binding activity for 125I-labeled PNA, but there was no difference in binding activity for PNA between "young" erythrocytes and "old" ones. Compared with "young" erythrocytes, decreases in the number and distribution density of receptor sites for five lectins including LPA, Con A, RCA-II, SBA and BPA on the cell surface were observed in aged erythrocytes. "Old" erythrocytes also showed a decrease in the number of PHA-E receptor sites, while the distribution density of the same receptor site remained unchanged. In view of these and other observations, it is thought that human erythrocyte aging is accompanied by elimination of some glycoconjugates which have affinity for six lectins, LPA, Con A, RCA-II, PHA-E, SBA and BPA, whereas no WGA receptor-containing glycoconjugates are released from erythrocyte membranes. Elimination of the glycoconjugates results in shrinkage of erythrocytes to reduce their cell surface areas.

Comparative study on the main membrane-surface sialoglycopeptides released from young and old human erythrocytes with trypsin

1. The amount of sialoglycopeptide (SGP) mixture released from young (Y) erythrocytes by trypsin treatment was significantly larger than that from old (O) ones. 2. The two main membrane-surface sialoglycopeptides (Y-SGP and O-SGP) were isolated in yields of about 45% and 42% from the mixtures by a combination of Sephadex G-50 superfine gel filtration with DEAE-cellulose chromatography, respectively. Molecular weights of 12,000 and 12,100, respectively, were found for the Y-SGP and the O-SGP. 3. The Y-SGP showed a greater proportion of sialic acid than the O-SGP. The contents of galactose, N-acetylglucosamine and N-acetylgalactosamine of the Y-SGP were significantly lower than those of the O-SGP. 4. Both the SGPs exhibited the same reactivities against the MN reagents, but the reactivities against the lectins of Limulus polyphemus and Phaseolus vulgaris (E) were stronger in the Y-SGP than in the O-SGP. Neither the Y-SGP nor the O-SGP showed the reactivity to Arachis hypogaea (anti-T) lectin.

Number and distribution density of ABH and MN antigen sites on young and old human erythrocyte surfaces

There were no differences in the number of A and M antigen sites between young and old human erythrocyte surfaces. No essential differences in the number of A1, N and Vicia graminea N antigen sites could be observed between young and old erythrocytes. The number of B and H antigen sites on cell surface was significantly higher in young erythrocytes than in old ones. The distribution density of A and M antigen sites on young erythrocyte was remarkably higher than that on old ones. Compared with young erythrocytes, significant increases in the distribution density of A1, B, H, N and Vicia graminea N antigen sites were observed in aged erythrocytes. It is suggested from these and other observations that human erythrocyte aging is accompanied by elimination of a small amount of B and H antigens from cell membranes, while A, A1, M, N and Vicia graminea N antigens are not released from cell membranes during in vivo aging.

Platelet aggregation in variant angina: its relation to plasma catecholamines

We concurrently measured plasma catecholamine levels and platelet aggregation in patients with variant angina, effort angina and old myocardial infarction. Platelet aggregability was lower in variant angina than in effort angina and old myocardial infarction. Plasma concentrations of epinephrine and norepinephrine in the variant angina group showed higher values than those in the effort angina group and the old myocardial infarction group. Moreover, there was a statistically significant negative correlation between plasma catecholamine concentration and ADP-induced platelet aggregation. These findings suggest that the lower platelet aggregation is related to the higher concentration of plasma catecholamine in variant angina.

Poorly differentiated adenocarcinoma of the rectum in a nephrotic patient with focal segmental glomerulosclerosis

We report herein a case of poorly differentiated adenocarcinoma of the rectum occurring in a nephrotic patient with focal segmental glomerulosclerosis. The neoplasm which first appeared to be a submucosal tumor occurred in a 29-year old Japanese man with a nephrotic syndrome for 2 years and 6 months. Autopsy disclosed a large tumor located between the rectum and urinary bladder. Renal specimens showed changes consistent with focal segmental glomerulosclerosis.

[Continuous recordings of the echocardiogram and electrocardiogram through the night in patients with nocturnal angina: "All-night echocardiography"]

Continuous observation of the left ventricular (LV) wall motion through the night has not been reported yet. So we developed the long-term recording system of the echocardiogram through all of the night, which was proved useful in a clinical setting. In order to record a long-term echocardiogram, a superimposed echocardiogram of each cardiac cycle was developed on the monitor television by using QRS complex as its trigger. This monitor view has a capacity to display such an echocardiogram with 2-channel electrocardiogram (ECG). Sudden changes of the cardiac motion during the recording were easily detected on the monitor view. These pictures were also recorded on the video cassette recorder through the video camera. We call this system "All-night echocardiography". Complete review of the video tape for 10 hours was possible for only 50 minutes by changing the speed of the review tape (one-twelfth of real time). A probe (Monitoring Probe) was fixed on the chest wall during the recording. "All-night echocardiograms" were recorded in eight patients for 10 hours in total 10 nights. LV posterior wall (PW) monitoring was succeeded in 3 patients for 4 nights during the anginal attack. Systolic motion of LVPW was decreased with ST elevation in a VF in the simultaneous ECG during spontaneous attack (Fig. 5).

Cytotoxicity of antiserum sensitized hemolytic streptococcal M protein fraction on cultured myocardial cells

We have studied cytotoxicity of antisera of monkeys sensitized to streptococcal M protein fraction, which was prepared by the method of Lancefield et al., on cultured myocardial cells. These antisera exerted a significantly higher cytotoxic effect on the myocardial cells than normal monkey sera, and this cytotoxic effect seemed to be organ-specific. In the presence of normal monkey lymphocytes, the antisera had a cytotoxic effect on myocardial cells, but normal sera in the presence of normal monkey lymphocytes had no cytotoxic effects. These data suggest that M protein fraction of hemolytic streptococcus plays an important role in the pathogenesis of rheumatic carditis.