Aldose reductase C-106T gene polymorphism is associated with diabetic retinopathy in Japanese patients with type 2 diabetes

It is likely that the C allele of the polymorphism at position -106 in the promoter of aldose reductase gene, which codes a rate-limiting enzyme of the polyol pathway, is a susceptibility allele for diabetic retinopathy in Japanese type 2 diabetic patients.

Long-term lifestyle intervention lowers the incidence of stroke in Japanese patients with type 2 diabetes: a nationwide multicentre randomised controlled trial (the Japan Diabetes Complications Study)

AIMS/HYPOTHESIS

The aim of the study was to clarify whether a therapeutic intervention focused on lifestyle modification affected the incidence of vascular complications in patients with established diabetes.

METHODS

A total of 2,033 eligible Japanese men and women aged 40-70 years with type 2 diabetes from 59 institutes were randomised to a conventional treatment group (CON), which continued to receive the usual care, and a lifestyle intervention group (INT), which received education on lifestyle modification regarding dietary habits, physical activities and adherence to treatment by telephone counselling and at each outpatient clinic visit, in addition to the usual care. Randomisation and open-label allocation were done by a central computer system. Primary analysis regarding measurements of control status and occurrence of macro- and microvascular complications was based on 1,304 participants followed for an 8 year period.

RESULTS

Although status of control of most classic cardiovascular risk factors, including body weight, glycaemia, serum lipids and BP, did not differ between groups during the study period, the incidence of stroke in the INT group (5.48/1,000 patient-years) was significantly lower than in the CON group (9.52/1,000 patient-years) by Kaplan- Meier analysis (p=0.02 by logrank test) and by multivariate Cox analysis (HR 0.62, 95% CI 0.39-0.98, p=0.04). The incidence of CHD, retinopathy and nephropathy did not differ significantly between groups. Lipoprotein(a) was another significant independent risk factor for stroke.

CONCLUSIONS/INTERPRETATION

These findings suggest that lifestyle modification had limited effects on most typical control variables, but did have a significant effect on stroke incidence in patients with established type 2 diabetes.

CLINICAL TRIAL REGISTRATION

UMIN-CTR C000000222

FUNDING

The Ministry of Health, Labour and Welfare, Japan

Novel multiferroic state of Eu1-xYxMnO3 in high magnetic fields

Magnetic and dielectric properties of Eu1-xYxMnO3 (x=0 and 0.4) are studied in pulsed magnetic fields up to 55 T. For x=0, application of magnetic fields higher than 20 T along the b axis causes magnetic transitions accompanied by generation of electric polarization (P) along the a axis. Similar first-order transitions are also observed in crystals of x=0.4, in which the ground state at zero magnetic field is already a ferroelectric P parallel a phase of different origin. Realistic model calculation indicates the presence of a novel multiferroic state induced by the spin exchange striction mechanism in high magnetic fields as an essential nature of the frustrated Mn spin system in this class of manganites.

Unconventional ferroelectric transition in the multiferroic compound TbMnO3 revealed by the absence of an anomaly in c-polarized phonon dispersion

TbMnO(3) exhibits a spontaneous electric polarization along c concomitantly with a spiral spin ordering modulated along b below T_{C} = 28 K. We have performed inelastic x-ray scattering measurements on a single crystal of TbMnO(3) to clarify whether phonon anomalies related to the ferroelectricity exist. We measured transverse modes, especially the Mn-O-Mn bending mode polarized along c and propagating along b, which we expect is most relevant to the ferroelectricity. However, no anomaly was found in the phonon dispersion below 50 meV across T_{C}. The present result suggests that the mechanism of ferroelectricity in TbMnO(3) is different from that of a conventional displacive-type ferroelectric. The weak coupling between electric polarization and lattice in TbMnO(3) strongly suggests that the ferroelectricity is mainly derived from the spiral spin ordering.

Combined effect of oxidative stress-related gene polymorphisms on atherosclerosis

It is well known that oxidative stress plays critical roles in the pathogenesis of atherosclerosis. In this study, we enrolled 1746 type 2 diabetic subjects, determined 4 common genetic variants related to oxidative stress (glutamate-cysteine ligase modifier subunit (GCLM) C-588T, myeloperoxidase G-463A, human paraoxonase 1 Gln192Arg and NAD(P)H oxidase p22phox C242T polymorphisms), and measured carotid intima-media thickness (IMT) as a surrogate marker for atherosclerosis. GCLM C-588T polymorphism was associated with average IMT (AveIMT) (r=0.090, p=0.0008), but the association between the other 3 polymorphisms and AveIMT did not reach the statistical significance. However, AveIMT was significantly greater as the total number of 4 concomitant "pro-oxidant alleles" in each subject was increased (r=0.108, p<0.0001). Furthermore, the number of "pro-oxidant alleles" was a risk factor for a high AveIMT independently of conventional risk factors (p=0.0003). In conclusion, accumulation of oxidative stress-associated alleles was associated with carotid atherosclerosis in type 2 diabetic patients.

Evidence for an electric-dipole active continuum band of spin excitations in multiferroic TbMnO3

The wide range optical spectra on a multiferroic prototype TbMnO3 have been investigated to clarify the origin of spin excitations observed in the far-infrared region. We elucidate the full band structure, whose high energy edge (133 cm;{-1}) exactly corresponds to twice of the highest-lying magnon energy. Thus the origin of this absorption band is clearly assigned to two-magnon excitation driven by the electric field of light. There is an overlap between the two-magnon and phonon energy ranges, where the strong coupling between them is manifested by the frequency shift and transfer of oscillator strength of the phonon mode.

Cycloidal spin order in the a-axis polarized ferroelectric phase of orthorhombic perovskite manganite

The ferroelectric state in an orthorhombic perovskite RMnO3 (R=Gd0.7Tb0.3) was proved by neutron scattering studies to show the cycloidal spin state with the ab-spiral plane and the spin-helicity dependent polarization vector along the a axis, sharing the microscopic origin (inverse Dzyaloshinskii-Moriya interaction) with the more widely observed P||c state (e.g., for R=Tb and Dy) with the bc-spiral plane. The magnetic-field induced polarization flop from P||c to P||a as well known for RMnO3 is thus assigned to the orthogonal flop of the spin spiral plane from bc to ab.

Evaluation of lengthened callus by callotasis with analysis of mathematical morphology

BACKGROUND

Callotasis has become an established option for reconstruction of congenital anomalies and after resection of bone tumors. However, fracture after removal of the lengthener remains one of the most serious complications. Mathematical morphology is an image processing technique that allows the skeletal patterns of trabecular bone to be selectively extracted as binary images from computed radiographic (CR) images. We evaluated the strength of the lengthened callus by analysis using mathematical morphology and examined the utility of this method in a biomechanical study.

METHODS

Three Japanese white rabbits per time point were euthanized at the 2-, 3-, 4-, 6-, and 8-week points after completion of the lengthening and were evaluated by CR images and analysis with mathematical morphology.

RESULTS

The changes of the number and continuity of trabecular bone were obtained visually and could be evaluated quantitatively. In some cases corticalization appeared to be complete in the CR images, but it was not complete on the morphological images. Such cases were found to be weaker than those in which corticalization appeared to be complete on both CR and morphological images.

CONCLUSION

Analysis with mathematical morphology is useful for evaluating the lengthened callus after callotasis.

Correlation between spin helicity and an electric polarization vector in quantum-spin chain magnet LiCu2O2

Measurements of polarized neutron scattering were performed on a S=1/2 chain multiferroic LiCu2O2. In the ferroelectric ground state with the spontaneous polarization along the c axis, the existence of transverse spiral spin component in the bc plane was confirmed. When the direction of electric polarization is reversed, the vector spin chirality as defined by C_(ij)=S_(i)xS_(j) (i and j being the neighboring spin sites) is observed to be reversed, indicating that the spin-current model or the inverse Dzyaloshinskii-Moriya mechanism is applicable even to this e_(g)-electron quantum-spin system. Differential scattering intensity of polarized neutrons shows a large discrepancy from that expected for the classical-spin bc-cycloidal structure, implying the effect of large quantum fluctuation.

Magnetic field switching between the two orbital-ordered states in DyVO3

The critical phase competition between different spin-orbital-ordered states has been investigated for the DyVO3 single crystal. As temperature is lowered, the compound exhibits a reentrant spin and orbital ordering (SO and OO) transition: C-->G-->C type for SO and G-->C-->G type for OO. It was found that a magnetic field also drives the phase transition from C to G for OO and concomitantly from G to C for SO, the latter of which is coupled with the metamagnetic transition of the Dy 4f moments. The mechanism of this novel magnetic-field-induced orbital switching is discussed.

Desmin as a marker of proteinuria in early stages of membranous nephropathy in elderly patients

AIMS AND METHOD

Idiopathic membranous nephropathy (IMN) is the most common cause of nephrotic syndrome in adults worldwide. Many patients with IMN are elderly, but little is known about the relationship regarding the morphological stage determined by electron microscopy (EM), the amount of proteinuria, and the expression of glomerular podocyte markers such as desmin and nephrin in nephrotic glomeruli in IMN. We studied 59 patients with histopathologically proven IMN. We compared the clinical features, EM stage classification, and the immunohistochemical features of glomerular expression of podocyte markers, including desmin and nephrin, between older (age > or = 60 years) and younger (age < 60 years) patients. We also investigated these parameters in patients with minimal-change nephrotic syndrome (MCNS), minor glomerular abnormalities (MGA), and normal kidneys as age-matched controls.

RESULTS

Prevalence of nephrotic syndrome was significantly higher in the older (52.9%) than the younger group (20.0%) of IMN. The level of proteinuria was higher in early stages (Stages I + II) than in late stages (Stages III + IV) in IMN. The glomerular expression of desmin in podocytes was significantly higher in IMN as compared to MCNS, MGA, or age-matched controls. Desmin expression was significantly increased in earlier EM stages (Stages I + II) and in higher proteinuric group (daily proteinuria > or = 1 g) of older patients with IMN. Reciprocally, the reduced expression of nephrin was associated with the early EM stages (Stages I + II) of patients with IMN.

CONCLUSIONS

We conclude that the expression of desmin in podocytes is upregulated in patients with IMN as compared to other glomerular diseases including MCNS or MGA, or to controls. In elderly patients with IMN, desmin expression was associated with early EM stages and heavy proteinuria, which may reflect phenotypic alteration of the podocyte.

Electric control of spin helicity in a magnetic ferroelectric

Magnetic ferroelectrics or multiferroics, which are currently extensively explored, may provide a good arena to realize a novel magnetoelectric function. Here we demonstrate the genuine electric control of the spiral magnetic structure in one such magnetic ferroelectric, TbMnO3. A spin-polarized neutron scattering experiment clearly shows that the spin helicity, clockwise or counterclockwise, is controlled by the direction of spontaneous polarization and hence by the polarity of the small electric field applied on cooling.

Focal cerebral ischemia/reperfusion injury in mice induces hematopoietic prostaglandin D synthase in microglia and macrophages

Hematopoietic prostaglandin D synthase is a key enzyme in synthesis of prostaglandin D. Hematopoietic prostaglandin D synthase is expressed in microglia of the developing mouse brain. This study determined the serial changes and cellular localization of hematopoietic prostaglandin D synthase, and its role in cerebral ischemia/reperfusion injury using C57BL/6 mice (n=84) and bone marrow chimera mice (n=16). The latter mice were selected based on their expression of enhanced green fluorescent protein in bone marrow/blood-derived monocytes/macrophages. The middle cerebral artery was occluded for 60 min, followed by reperfusion. Hematopoietic prostaglandin D synthase expression was examined by immunohistochemistry and Western blotting. Hematopoietic prostaglandin D synthase-positive cells were mainly expressed in the peri-ischemic area at 12 h (P<0.05) and 24 h (P<0.001) after reperfusion, while they were mostly found in the transition area at 48-72 h postreperfusion (P<0.001). There was a significant increase in staining intensity as well as number of hematopoietic prostaglandin D synthase-positive cells in the ischemic core at 5-7 (P<0.001) days postreperfusion. Hematopoietic prostaglandin D synthase-positive cells also co-expressed ionized calcium-binding adapter molecule 1, a marker of microglia/macrophages, and cyclooxygenase-2, but not markers of neurons, oligodendrocytes and astrocytes. Until 72 h postreperfusion, many enhanced green fluorescent protein-positive cells were negative for hematopoietic prostaglandin D synthase, but the number of hematopoietic prostaglandin D synthase-enhanced green fluorescent protein coexpressing cells increased significantly at 5-7 days after reperfusion. Our results indicate that hematopoietic prostaglandin D synthase is mainly produced by endogenous microglia until 72 h after reperfusion, but at 7 days after reperfusion, it is also produced by migrating bone marrow/blood-derived macrophages in the ischemic brain tissue. We speculate that hematopoietic prostaglandin D synthase in the brain has different functions during early and late phases of ischemia.

Association of soluble CD40 ligand with carotid atherosclerosis in Japanese type 1 diabetic patients

AIMS/HYPOTHESIS

It has recently been shown that the soluble form of CD40 ligand (sCD40L) interacts with CD40 on vascular cells, leading to a variety of proinflammatory responses, and that serum sCD40L levels can be a predictive marker of cardiovascular events. The aim of this study was to estimate sCD40L levels in type 1 diabetic patients to examine a possible association with carotid atherosclerosis.

SUBJECTS AND METHODS

Human sCD40L levels in serum and intima-media thickness (IMT) of carotid artery were examined in 80 Japanese type 1 diabetic patients (27 men and 53 women, age 22.8+/-3.4 years (mean+/-SD), duration of diabetes 13.2+/-6.1 years) and 20 healthy age-matched non-diabetic individuals.

RESULTS

Serum sCD40L levels were significantly (p=0.0185) higher in subjects with type 1 diabetes (2.10+/-1.33 ng/ml) compared with non-diabetic subjects (1.35+/-0.88 ng/ml). The greatest IMT (Max-IMT) and averaged IMT (Mean-IMT) were also significantly greater in patients with type 1 diabetes than in control subjects (0.73+/-0.14 vs 0.64+/-0.07 mm, p=0.0041, 0.63+/-0.09 vs 0.57+/-0.06 mm, p=0.0066, respectively). Levels of sCD40L were statistically significantly associated with Max-IMT (r=0.383, p<0.001) and Mean-IMT (r=0.275, p=0.0058). Furthermore, stepwise multivariate regression analyses demonstrated that sCD40L is a determinant of both Max- and Mean-IMT, independently of conventional risk factors.

CONCLUSIONS/INTERPRETATION

It is suggested that increased levels of serum sCD40L are associated with accelerated atherosclerotic change observed in young patients with type 1 diabetes.

Intravenous cyclophosphamide therapy for progressive interstitial pneumonia in patients with polymyositis/dermatomyositis

OBJECTIVES

To study the efficacy and safety of monthly intravenous pulse cyclophosphamide (IVCYC) therapy for progressive interstitial pneumonia in polymyositis/dermatomyositis (PM/DM).

METHODS

Seventeen patients with PM/DM/amyopathic DM (mean age 51.4 +/- 10.4, mean follow-up 32 months) who received IVCYC for progressive interstitial pneumonia between August 1993 and October 2002 were studied. Nine patients had failed to respond to previous treatment with high-dose steroid and/or immunosuppressant. Cyclophosphamide (300-800 mg/m2) was given at least six times every 4 weeks. Oral prednisolone (0.5-1 mg/kg/day) was administered for the first 2 weeks and was gradually tapered. Response to treatment was evaluated based on the degree of exertional dyspnea, pulmonary function test and high-resolution computed tomography (HRCT).

RESULTS

Eleven of 17 patients showed improvement in their dyspnea; six out of seven patients who had required oxygen treatment before IVCYC no longer did so after IVCYC. Eight of 17 patients had >or=10% improvement of vital capacity (VC)% and 9/17 had >or=10 point reduction in their HRCT score. Twelve patients had exhibited at least one result. Two patients with anti-Jo-1 antibodies showed a flare-up of interstitial pneumonia or myositis. After the IVCYC therapy, mean VC% improved by 15% (from 68 to 83%, P = 0.0034). The extent of abnormal lesions in HRCT was reduced from 24 to 13% (P = 0.0055). There was neither death nor severe toxicities observed.

CONCLUSIONS

In this open-label study, IVCYC improved symptoms, pulmonary function tests and HRCT findings in patients with PM/DM. Longitudinal controlled studies are required to further confirm the efficacy of IVCYC.

Magnetic reversal of the ferroelectric polarization in a multiferroic spinel oxide

Ferroelectric transition has been detected in a ferrimagnetic spinel oxide of CoCr2O4 upon the transition to the conical spin order below 25 K. The direction [110] of the spontaneous polarization is normal to both the magnetization easy axis [001] and to the propagation axis [110] of the transverse spiral component, in accord with the prediction based on the spin-current model. The reversal of the spontaneous magnetization by a small magnetic field (approximately 0.1 T) induces the reversal of the spontaneous polarization, indicating the clamping of the ferromagnetic and ferroelectric domain walls.

Good response of membranous lupus nephritis to tacrolimus

A 22-year-old woman hospitalized for polyarthralgia was diagnosed with systemic lupus erythematosus (SLE). She was treated with prednisolone, and her clinical manifestations improved. However, she was re-admitted for renal biopsy because of persistent hypocomplementemia and development of proteinuria. The biopsy revealed segmental spike formation of basement membrane and subepithelial immune complex deposition, and membranous lupus nephritis (class V) was diagnosed. When tacrolimus was added to prednisolone, the serum complement titer quickly improved and proteinuria disappeared after about 11 months. Nevertheless, when tacrolimus was replaced examination showed cyclosporine due to gastrointestinal symptoms, she complained about arthralgia. Examination showed drop in the serum complement titer and recurrence of proteinuria. Renal biopsy at the time of recurrence showed increased subepithelial immune complex deposition in the capillary loops as compared to the first biopsy, a high degree of thickening of the basement membrane, and segmental circumferential interposition in some of the glomeruli. Membranous lupus nephritis (classes V + III) was diagnosed. By changing to tacrolimus and higher doses of steroids, the serum complement titer improved and proteinuria disappeared. This case indicates that tacrolimus can be an effective therapeutic agent for membranous lupus nephritis.

Reproducibility of a method for analysis of morphological changes in perioral soft tissue in children using video cameras

The purpose of the present study was to determine the appropriate reference facial expression and to examine the reproducibility of our system using two commercially available video cameras in consideration of functional diagnosis of perioral muscles. The following items were investigated: 1) influence of forward and backward movements and the experiment sequence from measurement to analysis, 2) usefulness of head fixation by a restraining device during video recording for evaluation of morphological changes in facial expression, 3) conditions for establishment of reference points for determination of movements of perioral soft tissue, and 4) reproducibility of perioral soft tissue movements as assessed by changes in landmarks. The results of this study showed that accurate static and dynamic evaluation of perioral soft tissue is possible by using our method of video recording with the subject's head restrained and our method of analysis. The results also showed that centric occlusion of the most appropriate reference facial expression as for measurement of perioral soft tissue movements and that protrusion of the lips and lateral extension of the angel of the mouth are facial expressions with high degrees of reproducibility.

Increased stress protein ORP150 autoantibody production in Type 1 diabetic patients

AIMS

Various genetic and environmental stresses interfere with protein folding in the endoplasmic reticulum (ER), which leads to the induction of ER stress. It has recently been reported that ER stress is involved in the development of diabetes in diabetic animal models. The aim of this study is to estimate ER stress levels in Type 1 diabetic patients.

METHODS

We recruited Type 1 diabetic patients undergoing periodic follow-up examinations (n = 91) and healthy non-diabetic individuals (n = 37), and measured their serum anti-oxygen-related protein (ORP)150 autoantibody levels.

RESULTS

Anti-ORP150 autoantibody levels in Type 1 diabetic patients were significantly higher compared with those in healthy non-diabetic subjects. Furthermore, the serum autoantibody levels in Type 1 diabetic patients correlated with HbA(1c) (F > 3.0, P = 0.079), indicating that hyperglycaemia itself induces ER stress in diabetes.

CONCLUSIONS

Anti-ORP150 autoantibody levels in Type 1 diabetic patients are higher compared with non-diabetic subjects, suggesting that ER stress is increased in Type 1 diabetes.

A case of monoclonal immunoglobulin light- and heavy-chain deposition disease exhibiting atypical deposition with fibrillary structures, successfully treated with chemotherapy

We report a case of light and heavy chain deposition disease (LHCDD), a rather rare monoclonal immunoglobulin deposition disease (MIDD) with successful therapeutic effect. A 58-year-old woman suffered from proteinuria and renal insufficiency (serum creatinine 1.0 mg/dl, creatinine clearance 49.2 ml/min) in February 2003. In serum and urine samples, monoclonal IgG-kappa was detected. A bone marrow aspiration showed a slightly hypocellular marrow and plasma cell population was increased to 7.0%. Renal histological findings revealed lobulated glomeruli with nodular lesions on light microscopy, characteristic findings of MIDD. Intense deposition of IgG heavy chains in the linear pattern in the glomerular and tubular basement membranes was observed. Immunohistochemistry revealed both kappa and lambda light chain depositions in glomeruli. Electron-microscopic examination revealed fine granular electron-dense deposits accompanied by microfibrils. Based on these findings, this patient was diagnosed as LHCDD. She received three courses of melphalan and prednisone chemotherapy, resulting in disappearance of proteinuria, prevention of renal functional deterioration and the decrease of monoclonal immunoglobulin. This case clearly demonstrates that the earlier and accurate diagnosis and initiation of chemotherapy at the early stage with serum creatinine level below 4.0 mg/dl are necessary to improve renal and patient outcome.

Transgenic over-expression of macrophage migration inhibitory factor renders mice markedly more susceptible to experimental colitis

Enhanced production of macrophage migration inhibitory factor (MIF) is recognized in patients with inflammatory bowel disease (IBD) and mice with experimental colitis; however, the precise molecular function of MIF in colitis is not fully understood. To further investigate this matter, we examined the pathological features of MIF transgenic mice with dextran sulphate sodium (DSS)-induced colitis. We generated transgenic mice carrying a murine MIF cDNA driven by a cytomegalovirus enhancer and a beta-actin/beta-globin promoter. Mice were orally administered 1-4% DSS in drinking water for 7 days. Clinical disease activity, survival and histological features were evaluated. The level of myeloperoxidase (MPO) activity in the colon tissue was measured to assess neutrophil infiltration. The level of corticosterone in the serum was measured by enzyme linked-immunosorbent assay (ELISA). MIF mRNA and protein were markedly up-regulated in the colon and serum obtained from MIF transgenic mice. The severity of the colitis induced by 1% DSS treatment was markedly higher in MIF transgenic mice than in wild-type mice. We also found that MPO activity was significantly higher in MIF transgenic mice than wild-type mice in response to DSS stimulation. Interestingly, the corticosterone level remained unchanged in MIF transgenic mice. MIF enhances DSS-induced colitis, in part via neutrophil accumulation and inhibition of glucocorticoid bioactivity.

Metformin or gliclazide, rather than glibenclamide, attenuate progression of carotid intima-media thickness in subjects with type 2 diabetes

AIM/HYPOTHESIS

Metformin is a well-known oral hypoglycaemic agent and has been commonly used, in combination with sulphonylurea, to treat type 2 diabetes. However, the advantageous effect of metformin plus sulphonylurea on diabetic macroangiopathy has yet to be clarified. To evaluate whether sulphonylurea or sulphonylurea plus metformin prevent diabetic macroangiopathy, we examined the progression of carotid artery intima-media thickness (IMT) as a surrogate end point.

METHODS

Subjects with type 2 diabetes were divided into three groups, receiving the following treatments: (i) glibenclamide (n=59); (ii) gliclazide (n=30); and (iii) glibenclamide + metformin (n=29). Maximum IMT and average IMT (the greatest value among 6 average values of each 3 points including greatest thickness) were measured at the beginning and end of the observation period.

RESULTS

For the follow-up period of 3 years, the annual change in average IMT of the glibenclamide plus metformin group (0.003+/-0.048 mm) was smaller than that of the glibenclamide group (0.064+/-0.045 mm) and gliclazide group (0.032+/-0.036 mm) (p<0.0001 and p=0.043 respectively). In the gliclazide group, average IMT increased during the follow-up period, but annual change in average IMT was significantly smaller than that of the glibenclamide group (p=0.005). Glibenclamide + metformin or gliclazide also attenuated the progression of maximum IMT, compared with that of glibenclamide (0.041+/-0.105, 0.044+/-0.106, 0.114+/-0.131 mm/year respectively, p=0.029 and p=0.035 respectively). Multivariable regression analysis implied that administration of metformin or gliclazide significantly and independently (p<0.05) reduces the progression of average IMT, compared with glibenclamide monotherapy.

CONCLUSIONS/INTERPRETATION

These data indicate that metformin or gliclazide, rather than glibenclamide, have a potent anti-atherogenic effect in type 2 diabetes.

Ectopically expressed PDX-1 in liver initiates endocrine and exocrine pancreas differentiation but causes dysmorphogenesis

To date, the potency of pancreatic and duodenal homeobox gene 1 (PDX-1) in inducing differentiation into insulin-producing cells has been demonstrated in some cells and tissues. In order to carry out efficient screening of somatic tissues and cells that can transdifferentiate into beta-cell-like cells in response to PDX-1, we generated CAG-CAT-PDX1 transgenic mice carrying a transgene cassette composed of the chicken beta-actin gene (CAG) promoter and a floxed stuffer DNA sequence (CAT) linked to PDX-1 cDNA. When the mice were crossed with Alb-Cre mice, which express the Cre recombinase driven by the rat albumin gene promoter, PDX-1 was expressed in more than 50% of hepatocytes and cholangiocytes. The PDX-1 (+) livers expressed a variety of endocrine hormone genes such as insulin, glucagon, somatostatin, and pancreatic polypeptide. In addition, they expressed exocrine genes such as elastase-1 and chymotrypsinogen 1B. However, the mice exhibited marked jaundice due to conjugated hyperbilirubinemia, and the liver tissue displayed abnormal lobe structures and multiple cystic lesions. Thus, the in vivo ectopic expression of PDX-1 in albumin-producing cells was able to initiate but not complete the differentiation of liver cells into pancreatic cells. The conditional PDX-1 transgenic mouse system developed in this study appeared to be useful for efficient screening of PDX-1 responsive somatic tissues and cells.

Action of FGMgCO3Ap-collagen composite in promoting bone formation

To improve the biological properties of materials as bone substitutes, functionally graded CO3 apatite crystals containing magnesium, FGMgCO3Ap, were synthesized to be mixed with atelocollagen and made into a composite pellet. A radio-labeled cell adhesion experiment showed that the degree of adherence of mouse MC3T3E1 osteoblast-like cells to the FGMgCO3Ap-collagen composite was better than to CO3Ap-collagen and much better than to the Ti plate. When the composites were implanted beneath the periosteum cranii of rats, the FGMgCO3Ap-collagen composite was metabolized faster than the CO3Ap-collagen composite and better formation of new bone and osteoblast arrangement at the interface between the composite and the periosteum cranii was observed. When the composites were implanted into the femur of rabbits, clear bone formation with a higher degree of bone density was observed for the FGMgCO3Ap-collagen composite. These results suggest that the Mg2+ ions taken into the apatite crystals may contribute to the acceleration of osteoblast adhesion to apatites and promote bone formation, cross-talking with osteoblasts at the molecular level.

Longitudinal observation of basic mandibular movements: report of a case

Sound development of mandibular function during childhood is indispensable to establishing healthy function in adults. To examine this developmental process, longitudinal recordings of basic mandibular movements were done using an optoelectronic analysis. Mandibular movements were recorded on five separate occasions in one boy, from an age of six years and five months to 14 years and five months. The incisor pathways during protrusion and lateral excursion were initially shallow, with more anterior than inferior movement, but as he grew the amount of inferior movement and the amount of rotation both increased. Similarly, at his first recording there was very little hinge-like rotation during mouth closing, but rotation increased markedly after eruption of his permanent second molars. These findings suggest that mandibular movements change from being relatively simple with more translation in younger children to more complex movements with more rotation once the permanent dentition is established.

Length of the occlusal glide at the lower incisal point during chewing

The purpose of this study was to estimate the length of the occlusal glide during gum chewing at the lower incisal point. Mandibular excursions with occlusal contacts in 25 females with permanent dentition were recorded using an optoelectronic system that can measure mandibular movement with 6 d.f. at a sampling frequency of 100 Hz. A curved mesh diagram of incisor coordinates during maximum mandibular excursions (CMDME) was plotted. Gum chewing movement was also measured using the same system and computer software which divided the chewing movement into cycles at each maximum opening position. Each cycle was standardized at 0.1 mm intervals from the most closed position. Finally, the distance between the CMDME and each position of the incisor during a chewing cycle was calculated. Whenever, this distance was less than 0.2 mm opposing teeth were considered to be in contact. The occlusal glide was defined as the distance travelled by the lower incisal point as the mandible moved along occlusal contacts of the CMDME. The vertical coordinates at the beginning of the occlusal glide (during closing) and at the end of occlusal glide (during opening) were also calculated. The lengths of the occlusal glide pathway averaged 1.29 mm during closing and 1.55 mm during opening, a total length of 2.84 mm. Mean vertical coordinates at the beginning and end of the glide were -0.95 and -1.12 mm from intercuspal position, respectively.

Association of (-)786T-C mutation of endothelial nitric oxide synthase gene with insulin resistance

AIMS/HYPOTHESIS

Endothelial derived nitric oxide synthase ( eNOS) gene polymorphisms affect eNOS activity and are associated with abnormal vasomotility and impaired local blood flow. A decrease in local blood flow has been reported to cause insulin resistance. The aim of this study was to examine a possible association of two eNOS polymorphisms, Glu298Asp (G894T) in exon 7 and (-)786T-C mutation with insulin resistance.

METHODS

Genotypes of both Glu298Asp and (-)786T-C mutation were examined by the PCR-RFLP method. Plasma nitrate and nitrite concentrations were also measured.

RESULTS

The allele frequencies of both polymorphisms showed no considerable differences in 233 non-diabetic subjects and 301 patients with Type II (non-insulin-dependent) diabetes mellitus. Non-diabetic subjects with the (-)786C allele had (p<0.05) higher fasting plasma insulin and homeostasis model assessment of insulin resistance than those with the (-)786T/ (-)786T genotype. Diabetic subjects with (-)786C allele showed higher HbA(1c) than those with the (-)786T/(-)786T genotype. A euglycaemic hyperinsulinemic clamp study done on 71 of the 301 patients showed a lower glucose infusion rate in diabetic patients with the (-)786C allele than those without it. In diabetic patients with the (-)786C allele, plasma nitrate and nitrite concentrations were lower than in subjects without it (p=0.026). No differences were observed between mutant carriers of Glu298Asp and non-carriers among both non-diabetic subjects and Type II diabetic patients.

CONCLUSIONS/INTERPRETATION

The (-)786T-C mutation of the eNOS gene is associated with insulin resistance in both Japanese non-diabetic subjects and Type II diabetic patients.

Synthesis of functionally graded MgCO3 apatite accelerating osteoblast adhesion

As a means of improving the biological properties of materials for use as bone substitutes, functionally graded carbonate apatite containing Mg, FGMgCO3Ap, was synthesized at 60 degrees C and pH 7.4 using a gradient magnesium supply system. X-ray diffraction analysis of FGMgCO3Ap showed a poorly crystallized apatitic pattern, similar to that of human bone. ESCA analysis clearly showed the negative gradient distribution in Mg1s intensity (atomic concentration) of magnesium from the crystal surface toward the inner core. When the FGMgCO3Ap crystals were mixed with collagen, the resulting FGMgCO3Ap-collagen composite, irradiated with UV light for 4 h, retained their features in the saline solution. After washing away the nonadhesive cells, a cell adhesion assay showed that the optical density of the FGMgCO3Ap-collagen composite was higher than that of the CO3Ap-collagen composite. SEM observation showed that the osteoblast-like cells adhered well to the surface of the FGMgCO3Ap-collagen composite. Staining with hematoxylin-eosin and alizarin red confirmed the existence of a great many more cells and a thicker extracellular matrix layer on the FGMgCO3Ap-collagen composite than on the CO3Ap-collagen composite. This result demonstrated the acceleration effect of magnesium ions on osteoblast adhesion on the FGMgCO3Ap-collagen composite.

Substitution of Dmo1 with normal alleles results in decreased manifestation of diabetes in OLETF rats

AIM

Dmo1 (Diabetes Mellitus OLETF type I) is a major quantitative trait locus for dyslipidaemia, obesity and diabetes phenotypes in the Otsuka Long Evans Tokushima Fatty (OLETF) rat strain. To evaluate possible metabolic and pathological improvements generated by correction of the Dmo1 genetic pathway, we produced congenic lines, in which both OLETF Dmo1 alleles are replaced by the F344-derived genome.

METHODS

Congenic animals were produced by introgressing F344-derived Dmo1 alleles into the OLETF rat. Congenic animals of the fourth generation (BC4) were intercrossed to obtain F1 animals (BC4:F1). Animals of the next generation, BC4:F2, were used for this study. We used 23 BC4:F2 males harbouring homozygous replacement of the OLETF Dmo1 region with the F344-derived genome. Seven animals with OLETF-derived Dmo1 alleles were used as controls.

RESULTS

Dmo1-F344/F344 congenic rats showed significant decreases in body weight, abdominal fat weight, serum triacylglycerols, total cholesterol, food consumption and blood glucose after glucose loading (13%, 39%, 45%, 27%, 18% and 27% respectively; p < 0.05) compared with Dmo1-OLETF/OLETF animals. Furthermore, histopathological analysis of the kidney showed that mesangial sclerosis, hyalin deposits and deposition of PAS-positive substance were significantly lower in Dmo1-F344/F344 animals (p < 0.05).

CONCLUSION

Improvements in metabolic parameters and histopathological scores show that correction of the Dmo1 genetic pathway in the diabetic and mildly obese OLETF rat strain produces wide-ranging therapeutic effects. Thus, this pathway might represent a new drug target also applicable to humans.

Analysis of chromosomal aberrations involving chromosome 1q31-->q53 in a DMBA-induced rat fibrosarcoma cell line: amplification and overexpression of Jak2

In a study of DMBA-induced rat fibrosarcomas we repeatedly found deletions and/or amplifications in the long arm of rat chromosome 1 (RNO1). Comparative genome hybridization showed that there was amplification involving RNO1q31-->q53 in one of the DMBA-induced rat fibrosarcoma tumors (LB31) and a cell culture derived from it. To identify the amplified genes we physically mapped rat genes implicated in cancer and analyzed them for signs of amplification. The genes were selected based on their locations in comparative maps between rat and man. The rat proto-oncogenes Ccnd1, Fgf4, and Fgf3 (HSA11q13.3), were mapped to RNO1q43 by fluorescence in situ hybridization (FISH). The Ems1 gene was mapped by radiation hybrid (RH) mapping to the same rat chromosome region and shown to be situated centromeric to Ccnd1 and Fgf4. In addition, the proto-oncogenes Hras (HSA11p15.5) and Igf1r (HSA15q25-->q26) were mapped to RNO1q43 and RNO1q32 by FISH and Omp (HSA11q13.5) was assigned to RNO1q34. PCR probes for the above genes together with PCR probes for the previously mapped rat genes Bax (RNO1q31) and Jak2 (RNO1q51-->q53) were analyzed for signs of amplification by Southern blot hybridization. Low copy number increases of the Omp and Jak2 genes were detected in the LB31 cell culture. Dual color FISH analysis of tumor cells confirmed that chromosome regions containing Omp and Jak2 were amplified and were situated in long marker chromosomes showing an aberrant banding pattern. The configuration of the signals in the marker chromosomes suggested that they had arisen by a break-fusion-bridge (BFB) mechanism.

Nonspecific interstitial pneumonia as pulmonary involvement of primary Sjögren's syndrome

The pathologic patterns of lung involvement in nine patients with Sjögren's syndrome (SjS) are evaluated. The patients consisted of three males and six females, with a median age of 59 years. The SjS was diagnosed according to the criteria of the First International Seminar on SjS. In all patients, high-resolution computed radiographic scanning (HRCT) of the lungs was performed, and apparent honeycomb or microhoneycomb formation was observed in six patients. Pathologically, six patients were diagnosed with usual interstitial pneumonia (UIP), and three were diagnosed with nonspecific interstitial pneumonia/fibrosis (NSIP) (group II). There were no apparent honeycomb formations on HRCT in patients diagnosed with NSIP. In conclusion, NSIP is also a possible histologic classification of interstitial pneumonia associated with SjS.

The tubulovesicular system of gastric parietal cells is connected to the intracellular canaliculus, rough endoplasmic reticulum and Golgi complex. A study by high resolution scanning electron microscopy

The three-dimensional configuration of the tubulovesicular system of resting rat gastric parietal cells was determined by ultra-hihg-resolution scanning electron microscopy (SEM). Rat gastric mucosae were fixed in 1.0% glutaraldehyde and 0.5% formaldehyde in cacodylate buffer, (334 milliosmoles/kgH2O (mOsm)). To render cytoplasmic membranes visible by SEM, fixed mucosae were frozen and fractured, and the cytoplasm of fractured parietal cells was macerated by the aldehyde-osmium-DMSO-osmium procedure. With much of the cell matrix and filaments removed, SEM revealed numerous 30-60 nm tubukes, which formed a meshwork and also small cisternae about 100 nm. Some cisternae had a small, central 10 nm fenestration. The cytoplasmic surface of the tubules was smooth surfaced but some cisternal areas had attached polyribosomes. Isolated vesicles or tubules were not found in adequately macerated parietal cells. The tubulocisternal network was also connected to the Golgi apparatus. In favorable sites connections of the tubular membranes to the canaliculi were clearly visible. Continuity between these two membrane compartments suggests the probability of rapid membrane transposition when cells are stimulated to secrete acid.

A phosphodiesterase inhibitor, cilostazol, prevents the onset of silent brain infarction in Japanese subjects with Type II diabetes

AIMS/HYPOTHESIS

This study aimed to evaluate the effect of a phosphodiesterase inhibitor, cilostazol, on the prevention of silent brain infarction in diabetic patients without symptoms of vascular events.

METHODS

A total of 89 subjects were allocated at random to the cilostazol group ( n = 43) or the control group ( n = 46).

RESULTS

After the study period (3.2 +/- 0.5 years), carotid intima-media thickness (IMT) (means +/- SD) had increased ( p < 0.01) by 0.18 +/- 0.19 mm in the control group. In the cilostazol group, intima-media thickness showed almost no change (-0.00 +/- 0.16 mm). In the control group, 2 out of 46 subjects showed symptomatic brain infarctions and 10 out of 34 subjects without infarct-like region assessed by standard brain MRI examination showed silent brain infarctions after the observation period. On the other hand, no subjects in the cilostazol group showed silent brain infarction or strokes during the study period. Both at the beginning and end of the study period, the number of infarct-like regions positively correlated with IMT ( r = 0.335, p < 0.001 or r = 0.347, p < 0.001 respectively). The progression of infarct-like regions was directly related to the increase in IMT during the study period ( r = 0.299, p = 0.004).

CONCLUSION/INTERPRETATION

These data demonstrated that cilostazol could prevent the onset of silent brain infarction in Japanese subjects with Type II (non-insulin-dependent) diabetes mellitus. Also, an increase in intima-media thickness of the carotid artery wall could be able to predict the onset of silent brain infarction.

Complete response of a stage IV mucinous cystadenocarcinoma of the ovary to systemic chemotherapy employing paclitaxel and carboplatin

BACKGROUND

The survival rate of patients with advanced-stage mucinous cystadenocarcinoma of the ovary is dismal and no best treatment is known. We report a case of complete response of a stage IV mucinous cystadenocarcinoma of the ovary to systemic chemotherapy employing paclitaxel and carboplatin.

CASE

A 51-year-old nullipara diagnosed with International Federation of Gynecology and Obstetrics stage IV mucinous cystadenocarcinoma of the ovary underwent cytoreductive surgery followed by systemic chemotherapy employing paclitaxel and carboplatin every 4 weeks for 3 courses. The patient tolerated chemotherapy well, demonstrated a remarkable response showing no evidence of malignancy at a second-look laparotomy. As a consolidation chemotherapy after negative second-look laparotomy, she underwent another three courses of chemotherapy of the same regimen, and is showing no evidence of disease.

CONCLUSION

Paclitaxel and carboplatin may be effective in treating mucinous cystadenocarcinoma of the ovary.

Methylprednisolone accelerates the resolution of glomerulonephritis by sensitizing mesangial cells to apoptosis

Glucocorticoid has long been used to treat patients with glomerulonephritis because it ameliorates mesangial cell proliferation and proteinuria, in part by suppressing nuclear factor-kappa B (NF-kappaB) activation, which regulates the transcription of various pro-inflammatory genes. Recent evidence shows that NF-kappaB activation increases the resistance to TNF-alpha-induced apoptosis in mesangial cells. We examined glomerular cell proliferation and apoptosis along with NF-kappaB activation in the Thy-1.1 nephritis model. We also evaluated TNF-alpha-induced apoptosis in cultured mesangial cells. Methylprednisolone treatment ameliorated mesangial hypercellularity in Thy-1.1 nephritis by decreasing proliferating cells and increasing apoptosis in the glomeruli. These effects were associated with suppressed NF-kappaB activation. This in vitro study revealed that treatment with methylprednisolone and TNF-alpha induced cultured mesangial cell apoptosis. These results suggest that methylprednisolone may accelerate the resolution phase of Thy-1.1 nephritis in part by sensitizing mesangial cells to apoptosis.

Incisal and condylar paths during habitual mouth opening movement of children with anterior reverse bite in the primary dentition

The purpose of this study was to evaluate whether the path of habitual mouth opening was influenced by anterior reverse bite malocclusion in children. Two groups of children with the primary dentition were chosen: (i) 10 children with anterior reverse bite (reverse bite group) and (ii) 10 with normal occlusion (normal occlusion group). Their habitual mouth opening movements were measured by an opto-electronic movement-analysing system with 6 d.f. at a sampling rate of 100 Hz. These movements were projected on the sagittal plane at the incisal and condylar points. To characterize the path, we used the angles between the path and the horizontal plane. In the initial stage of opening, the incisal path of the reverse bite group was displaced more posteriorly from the intercuspal position than that of the normal occlusion group. However, as opening continued, the direction of the path of the reverse bite group was more anterior than those of the normal occlusion group. During the entire opening movement, the condylar path of the reverse bite group was flatter than those of the normal occlusion group. In conclusion, it was demonstrated that anterior reverse bite in the primary dentition clearly affects the paths of habitual opening movements.

Human T-cell leukemia virus type I tax protein induces the expression of anti-apoptotic gene Bcl-xL in human T-cells through nuclear factor-kappaB and c-AMP responsive element binding protein pathways

Human T-cell leukemia virus type I (HTLV-I) is the etiologic agent of adult T-cell leukemia (ATL), which is an aggressive form of human T-cell malignancy. The viral protein, Tax, immortalizes human T-cells and inhibits various types of apoptosis, and is thought to play crucial roles in the development of ATL. We have recently demonstrated that Tax induces the constitutive expression of the anti-apoptotic protein, Bcl-xL, in a mouse T-cell line. The mouse, however, is not a natural host of HTLV-I, and HTLV-I does not induce this malignancy in mice. We thus examined whether Tax also activates the expression of Bcl-xL in human T-cells. Expression of Tax in a human T-cell line, Jurkat, induced the expression of the Bcl-xL gene, but did not significantly affect the expression of the other apoptosis-related genes, Bcl-2 and Bax. Transient transfection assays showed that Tax stimulated human Bcl-xL promoter activity in Jurkat cells. Deletion of the two potential nuclear factor (NF)-kappaB binding sites in the human Bcl-xL promoter significantly decreased Tax-induced transactivation. In addition to NF-kappaB, Tax activates transcription through the c-AMP responsive element binding protein (CREB). Tax mutants segregating these two pathways showed that both the NF-kappaB and CREB pathways of Tax are required for maximum activation of a human Bcl-xL promoter, nevertheless, NF-kappaB alone was sufficient for that of a mouse Bcl-xL promoter. Northern blot analysis showed that all the human T-cell lines expressing Tax had higher levels of Bcl-xL mRNA than HTLV-I-uninfected ones. Furthermore, the sample from one patient with ATL expressed higher levels of Bcl-xL mRNA compared with levels from uninfected peripheral blood mononuclear cells. Our results suggest that Tax induces the expression of Bc-xL through the NF-kappaB and CREB pathways in HTLV-I-infected human T-cells, and then inhibits apoptosis, and such inhibition is necessary for the infected cells to advance to the leukemia in vivo.