[Renal transplant calculi in a renal allograft treated with extracorporeal shock wave lithotripsy in a patient with persistent hyperparathyroidism: a case report]

Between 1984 and 1991, six of 105 renal transplant recipients at our institution formed urinary tract calculi after transplantation (5.7%). In these 6 patients, one case of nephrolithiasis in a transplanted kidney was treated with extracorporeal shock wave lithotripsy (ESWL). A 37-year-old woman underwent cadaveric renal transplantation twenty months before, and her renal function remained stable. However calculi in the transplanted kidney and bladder were formed and ESWL was used for the treatment of the renal calculus in the transplanted kidney. She was discharged from the hospital two weeks postoperatively while passing small gravel in the urine after successful fragmentation of the calculus without any major complications. As follow-up KUB film two weeks later demonstrated that all stone fragments had been passed, but she was treated again by ESWL four months later because IVP films four weeks later revealed recurrent calculi in the transplanted kidney. The stones were fragmented successfully and spontaneously passed with voiding. Moreover we performed total parathyroidectomy with autotransplantation for persistent hyperparathyroidism, with subsequent good clinical results.

Establishment of a new human cell line, LI90, exhibiting characteristics of hepatic Ito (fat-storing) cells

BACKGROUND

Thus far, human hepatic Ito (fat-storing) cell lines have not been established. Therefore, functional characteristics of Ito cells have not been fully investigated.

EXPERIMENTAL DESIGN

We established a new cell line, LI90, that exhibited characteristics compatible with those of Ito cells from a human hepatic mesenchymal tumor. LI90 cells were examined with phase-contrast microscopy, immunohistochemistry, and cytogenetics, and their vitamin A-storing activity was analyzed. To obtain a marker specific for Ito cells for immunohistochemical analyses, we raised mAb against LI90 cells and clarified the molecular nature of the Ag recognized with the new Ab using an expression cloning approach.

RESULTS

LI90 cells showed polygonal shape and had well developed alpha-smooth muscle actin filaments in their cytoplasm. In an overconfluent culture condition, LI90 cells aggregated to form a typical hills-and-valleys structure, LI90 cells produced various connective tissue components, such as collagen types I, III, IV, V, and VI, laminin, and fibronectin. In culture media containing vitamin A, LI90 cells formed many fat droplets in their cytoplasm, and fluorescence characteristic of vitamin A was observed in the droplets. By immunizing mice with LI90 cells, three separate mAb specifically reacting with Ito cells in human liver sections were established, and the Ag recognized with all three Ab were identified as extracellular matrix tenascin.

CONCLUSIONS

The above-described morphologic and functional characteristics, including vitamin A-storage and biosynthesis of tenascin, are compatible with those of Ito cells. Therefore, LI90 cells will be useful for in vitro studies of functions of human Ito cells.

[Examination on aspirin-induced asthma and hypersensitivity to steroids--a questionnaire to 850 asthma on hypersensitivity to non-steroidal anti-inflammatory drugs and hypersensitivity to steroids]

We surveyed 850 patients with bronchial asthma and investigated such clinical features as the frequency of aspirin-induced asthma and hypersensitivity to steroids in the 457 available answers. We divided them into two groups, one was ASN: the asthmatics who had history of hypersensitivity to non-steroidal anti-inflammatory drugs, another was non-ASN: the asthmatics who had no history of hypersensitivity to non-steroidal anti-inflammatory drugs, and compared the two groups. The survey showed that the frequency of ASN was 12.0%. Its frequency rose with the severity of asthma to a level of 29.0% in severe cases. In ASN it was more frequent rates of female, infectious type, severe cases, and ASN had more frequent histories of oral use of steroids, use of ambulance, treatment in emergency rooms, and hospitalization than non-ASN. The serum IgE level was lower in ASN. The patients were 6 in ASN, none in non-ASN who had histories of hypersensitivity to steroids. They were 1.3% in all patients. 5 of 6 had past asthma attack progressived severely by rapid injection of succinate ester steroids and 2 of 6 had past by rapid injection of phosphoric acid ester steroids. In conclusion it was considered that we had to avoid rapid injection of steroids to aspirin-induced asthma and severe cases who were doubtful of aspirin-induced asthma in case of treatment of asthma attack.

[Tissue type plasminogen activator (t-PA) and plasminogen activator inhibitor (PAI) in transplanted kidneys]

We have studied the involvement of fibrinolysis in acute rejection after kidney transplantation by analyzing changes in urinary levels of substances such as FDP, D-dimer, tissue plasminogen activator (t-PA) and plasminogen activator inhibitor (PAI). Fibrinolytic activity was found to be low (that is, PAI is dominant) during acute rejection, and it was elevated (that is, PA became dominant) as acute rejection subsided. It appears that the dominance of PA leads to an increase in the products of fibrinolysis and an elevation in the D-dimer/FDP ratio, resulting in disappearance of the acute rejection. Based on these findings, we thought it necessary to administer t-PA to kidney recipients so that PA becomes dominant earlier and the acute rejection can be reduced. It is necessary for us to directly study the phenomena within the kidneys. Therefore, we recently conducted a histochemical study of the distribution of t-PA, Urokinase type PA (u-PA) and PAI in transplanted kidneys. Transplanted kidney, which functioned well or showed signs of acute or chronic rejection, were biopsied. These renal samples as well as control samples (biopsied from normal nongrafted kidney) were examined as to distribution of t-PA, u-PA and PAI by the indirect enzyme complement method. In conclusion, t-PA, u-PA and PAI were detected in the glomeruli, arterioles, tubule and interstices of the control kidneys, well functioning grafts, acutely rejected grafts chronically rejected grafts. All samples showed intense chromatic responses in the arterioles and part of the tubules. On the whole, the chromatic response tended to be more intense in the acute rejection group than in the other group.

Elevation of interleukin-6 in inflammatory bowel disease is macrophage- and epithelial cell-dependent

Local interleukin-6 (IL-6) activity was studied using colonic mucosal tissues in inflammatory bowel disease (IBD) and inflammatory control patients. Active IBD specimens exhibited significantly higher IL-6 activity than control specimens in both cultures of isolated lamina propria mononuclear cells (LPMC) and mucosal tissues with an increased number of IL-6-producing cells. However, the activity in inactive IBD or inflammatory controls did not differ from controls. Northern blot analysis demonstrated IL-6 messenger RNA in LPMC and colonic epithelial cells isolated from active IBD specimens but not in control cells. Furthermore, immunofluorescent microscopic study of active IBD specimens showed more conspicuous staining of IL-6 in infiltrating LPMC (mostly CD68+ cells) and colonic epithelial cells. These results suggest that elevation of local IL-6 activity may be a characteristic feature of active IBD and both macrophages and colonic epithelial cells are the major cell types responsible for this phenomenon.

Ultrastructural, immunocytochemical and stereological investigation of hepatocytes in a patient with the mutation of the ornithine transcarbamylase gene

We studied a male newborn suffering from deficiency of ornithine transcarbamylase (OTC) that is due to a G-to-A substitution in codon 269 of the OTC gene. This study intends to define the cell biological mechanisms in this naturally occurring OTC mutation which may explain the mild clinical course in spite of the very low residual enzyme activity. Using immunogold labeling of thawed thin frozen sections of liver from this patient and a control liver, we analyzed the quantitative distribution of several mitochondrial proteins in the cytosol and the mitochondria of hepatocytes. In addition, the absolute volumes and surface densities of mitochondria and peroxisomes were determined. Our results show that the absolute volume of mitochondria in the patient's hepatocytes was increased to 141% (P < 0.001) without any change in the surface density indicating an increased number of mitochondria. In the patient's hepatocytes the peroxisomes were increased in size but not in number. The concentration of OTC was elevated in the cytosol (P < 0.001) and to a lesser extent in mitochondria (P < 0.01) of the patient's hepatocytes thus indicating a doubling of OTC relative to control liver cells. The quantity of OTC in mitochondria was 63% higher in diseased liver cells. By conventional thin section electron microscopy, mitochondria-like structures with poorly defined cristae and an electron-dense matrix were observed in the cytoplasm of the diseased hepatocytes. By immunoelectron microscopy, they contained the cytochrome c oxidase II subunit as well as DNA but lacked OTC, carbamylphosphate synthetase, F1-ATPase beta subunit and catalase. Thus it appears that these structures represent defective and probably degenerating mitochondria. Our data indicate that the reduced enzyme activity of the mutant OTC is partly compensated by an increased amount of enzyme molecules in the cytosol as well as mitochondria combined with an increase in the biogenesis of mitochondria.

IL-10 mediates immunosuppression following primary infection with Toxoplasma gondii in mice

Suppression of the host immune response by Toxoplasma gondii has been observed in both human and experimental murine infection. In this study, inbred mice were infected with T. gondii. At day 7 post-infection, the lymphoproliferative response to both mitogen and superantigen as well as parasite antigen were found to be significantly depressed. Using a transwell system, it was determined that the reduced proliferative response was due to soluble factor(s) being expressed by splenocytes from the infected mice. Isolation of the splenocytes into an adherent and nonadherent population suggested that both macrophages and T cells were able to produce at least one soluble factor. Tissue culture supernatant derived from the splenocytes of the infected mice contain increased levels of IL-10, whereas measurable IL-2 levels could not be quantitated. At day 7 post-infection, both a biologic assay for IFN-gamma in culture supernatant and the expression of IFN-gamma mRNA in the splenocytes were reduced. Antibody to IL-10 was able to partially neutralize (almost 50%) the in vitro immune downregulation of the tissue culture supernatant. Anti-IL-10 in combination with a nitric oxide (NO) antagonist was able to reverse the inhibitory activity of the culture supernatant by 85%. Since IL-10 is a potent antagonist of IFN-gamma, it may represent a critical cytokine involved in mediating T. gondii induced immunosuppression in the infected host.

Regulation of thyroid-stimulating hormone beta-subunit and growth hormone messenger ribonucleic acid levels in the rat: effect of vitamin A status

T3 inhibits transcription of the rat TSH beta gene, and two T3 response elements have been identified that bind T3 receptors and that share sequence homology with the consensus sequence that is also recognized by retinoic acid receptors (RARs). We, therefore, asked whether RA was a regulator of TSH beta gene expression in vivo. Using RNase protection analysis, we found that vitamin A deficiency led to a 2-fold increase in rat pituitary TSH beta messenger RNA (mRNA) levels, which returned to normal 18 h after treatment with RA (20 micrograms/rat). Vitamin A deficiency had no effect on TSH beta mRNA levels in hypothyroid rats. Coadministration of RA and T3 (10 micrograms/100g body wt) to either vitamin A-deficient or vitamin A-deficient, hypothyroid animals caused decreases in TSH beta mRNA content that were indistinguishable from those seen with T3 alone. Surprisingly, vitamin A deficiency had no significant effect on GH mRNA levels in euthyroid or hypothyroid rats. Furthermore, treatment of vitamin A-deficient, hypothyroid animals with RA for either 18 or 72 h had no effect on GH mRNA levels, whereas T3 caused 11-fold and 18-fold increases in GH mRNA, respectively, at these times. We also used transient transfection to test for direct, retinoid receptor-mediated regulation of TSH beta gene transcription by RA. A plasmid TSH beta luciferase, containing 0.8 kilobases of rat TSH beta gene 5'-flanking sequences, exon 1, and 150 base pairs of intron 1, was transfected into CV-1 cells. Cotransfection with RAR alpha and retinoid X receptor-beta induced TSH beta expression by 3.5-fold, and treatment with RA suppressed this induction by 46%. These results show that vitamin A levels play a significant role in regulating the expression of the TSH beta gene, but not the GH gene, in vivo and suggest that RA may suppress TSH beta gene transcription directly by an RAR-retinoid X receptor heterodimer-mediated mechanism.

Hypoplastic left heart syndrome with a single coronary artery originating from the pulmonary artery

A newborn male infant with hypoplastic left heart syndrome due to mitral and aortic atresia died on the third day of life. Autopsy revealed a single coronary artery originating from the pulmonary artery, reversed coarctation of the aorta, a coronary sinus type atrial septal defect and stenosis of the left subclavian artery. To our knowledge, hypoplastic left heart syndrome associated with a single coronary artery originating from the pulmonary artery has never been reported in the English or Japanese literature. This may be the first such case.

Identification of two new aberrant splicings in the ornithine carbamoyltransferase (OCT) gene in two patients with early and late onset OCT deficiency

Ornithine carbamoyltransferase (OCT) is a liver-specific enzyme located in the mitochondrial matrix. OCT deficiency is an X-linked disease with a heterogeneous phenotype, even in affected males. We studied two male patients (K.M., K.G.) with early and late onset, respectively. OCT activity was zero in the autopsied liver of patient K.M. and was 6% of control in the biopsied liver of K.G. Sequencing of OCT cDNAs revealed exon 5 skipping in K.M., resulting from a T-to-C transition of the initial dinucleotide of the 5' splicing donor site of intron 5, and a G-to-T transversion at position +45 in exon 9 (L304F) in K.G., providing three OCT mRNAs of different lengths: a normally spliced transcript, 23 bp insertion of intron 8 and the first 50bp missing within exon 9. Exon 5 skipping and two other aberrant splicings produced stop codons early downstream in mature OCT mRNAs. Expression study of a missense allele, L304F, transfected to cultured Cos 1 cells revealed a 34.4% value of the control. The difference of OCT activities between the patient liver and transfected cells (6% vs. 34%) can be explained by this splicing abnormality.

Clinical significance of S-T segment elevation in lead aVR in anterior myocardial infarction. Assessment by thallium-201 exercise scintigraphy

The significance of exercise-induced S-T elevation in aVR was studied in 57 patients with recent anterior infarction and single-vessel disease. S-T elevation in aVR was found at peak exercise in 24 patients. Although the initial defect area was similar in the groups with and without S-T elevation in aVR, the redistribution area was larger in the former group (p < 0.01). When three electrocardiographic criteria were used in the multivariate analysis, S-T elevation in aVR was the significant variable related to redistribution in the anterior wall. Thus, S-T elevation in aVR may indicate ischemia of the anterior wall.

Primary intraocular lymphoma mimicking late postoperative endophthalmitis

We treated a 65-year old woman with diffuse uveitis and an intraocular mass. The diffuse uveitis resolved with the administration of corticosteroids, but the intraocular mass did not respond to treatment. A transscleral biopsy of the lesion was performed. Histopathological study revealed non-Hodgkin's large-cell lymphoma. Immunohistochemical analysis showed that the tumor cells were derived from B-cells. The intraocular mass diminished after radiation therapy. The transscleral biopsy proved useful in establishing the correct diagnosis.

Mutations in the COL4A5 gene in Alport syndrome: a possible mutation in primordial germ cells

Using a combination of gene amplification with single strand conformation polymorphisms analysis and sequencing, we examined the COL4A5 gene in 37 patients with Alport syndrome. In patient A8, a single base insertion was noted at codon 1,597 tyrosine in exon 49. The premature terminal signal appeared and 89 amino acids (approximately one-third) of the non-collagenous domain were lost. The mutation was present in the mother, hence she is heterozygous. In patient A12, the nucleotide changed from C to T at codon 1,679 glutamine in exon 51, which created a termination codon, and 7 amino acids at the carboxyl terminus were lost. Gene tracking using peripheral leukocytes revealed that the parents did not carry the mutant allele, while the sister was heterozygous. DNA samples from hair roots and skin fibroblasts of the mother were normal and immunological examination of the epidermis of the mother indicated that the alpha 5(IV) chain was normally expressed. As these results suggest that somatic cells of the mother do not carry the mutant allele, the primordial germ cells possibly carry a fresh mutation in the mother of patient A12.

Expression of androgen receptor in X-linked spinal and bulbar muscular atrophy and amyotrophic lateral sclerosis

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Nerve fibers originating from the brain in the rat pineal complex

The distribution of central nerve fibers in the rat pineal complex was studied by means of fluorescence- and immunohistochemistry and electron microscopy. At 7 days after bilateral superior cervical ganglionectomy (SCG-X), blue-green fluorescent (catecholaminergic) fibers and tyrosine hydroxylase- and serotonin-immunoreactive fibers originating from the brainstem were detected in the deep pineal and the pineal stalk. These fibers were not observed in the superficial pineal. In some animals, a few oxytocin-immunopositive fibers were found in the proximal portion of the superficial pineal. The nerve fibers were submicroscopically counted in transverse sections at 6 levels with an interval of about 200 microns each in the pineal stalk. The number of nerve fibers showed 3 peaks, at the proximal-most, the intermediate and the distal-most levels. On the other hand, various types of synapses, axo-dendritic, axo-axonic and axo-pinealocytic, and many free terminals, were observed in the stalk. In these synapses, the majority of presynaptic swellings contained only clear vesicles, but some of them possessed aminergic (5-hydroxydopamine- or 5,6-dihidroxytriptamine-positive) vesicles or elementary granules. The reduction in the number of nerve fibers was most conspicuous in the distal-most level after the SCG-X. Based on these results, it is supposed that the proximal peak is formed by the central fibers going further to the stalk and turning back to the brain, the intermediate peak is formed by the terminal arborizations of the central fibers, and the distal peak shows penetration of the sympathetic fibers.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of adrenomedullin on renal hemodynamics and functions in dogs

In order to elucidate the role of adrenomedullin in the kidney, we investigated the effects of adrenomedullin on renal hemodynamics and urine formation in anesthetized dogs. Intrarenal arterial infusion of adrenomedullin (0.8, 4 and 20 ng.kg-1.min-1) elicited dose-dependent increases in renal blood flow (by 10, 26 and 37%, respectively) with no change in blood pressure or heart rate, indicating a renal vasodilatory action of adrenomedullin. The glomerular filtration rate did not increase with the lower two doses, but increased marginally by 9% at the highest dose. Infusion of adrenomedullin at the rates of 4 and 20 ng.kg-1.min-1 increased urine flow and the urinary excretion of sodium and potassium dose dependently. Arterial and renal venous plasma renin activity was unaffected by adrenomedullin. These findings indicate that adrenomedullin is a potent renal vasodilatory peptide with a diuretic action. Since the threshold for the renal vasodilatory action of adrenomedullin is close to its physiological concentration in human plasma, adrenomedullin may play an important role in the regulation of renal function.

Effects of N-(4-hydroxyphenyl)-retinamide on the number and cytotoxicity of natural killer cells in vitamin-A-sufficient and -deficient rats

N-(4-hydroxyphenyl)retinamide (4-HPR), a synthetic retinoid with anticarcinogenic activity, has been shown to lower the plasma retinol level rapidly and significantly. We reported previously that vitamin A-deficient rats (plasma retinol < 0.175 mumol/l) have a low number of natural killer (NK) cells in peripheral blood. To investigate the effects of 4-HPR on NK cell number and activity, two studies were conducted. In study 1, vitamin-A-sufficient rats were fed a 'therapeutic' dose of 4-HPR (2 mmol/kg of diet) for 30 days. Despite a low plasma retinol concentration (approximately 0.1 mumol/l), the number of NK cells was not reduced. Moreover, the NK cytolytic activity per cell was significantly elevated. White blood cell and differential counts were normal. In study 2, the biological activity of 4-HPR was examined in vitamin-A-deficient rats. Rats depleted of vitamin A were fed a diet containing 4-HPR (54.7 micrograms/g of diet) for 11 days. Vitamin-A-dependent processes including growth, hematocrit, lymphocyte count and the number of NK cells were restored. For comparison, another group of vitamin-A-deficient rats were repleted with retinoic acid (RA; 4.2 micrograms/g diet); this treatment also effectively restored these vitamin-A-dependent processes. Therefore, despite the plasma-retinol-lowering property of 4-HPR, treatment with this retinoid did not impair NK cell number or function. Indeed, 4-HPR showed vitamin A activity similar to RA, and may stimulate NK cell cytotoxicity.