Retrospective survey of urea cycle disorders: Part 1. Clinical and laboratory observations of thirty-two Japanese male patients with ornithine transcarbamylase deficiency

In a retrospective survey done from 1978-1988 in Japan, 32 male patients with ornithine transcarbamylase (OTC) deficiency were identified. We classified a neonatal and 2 late-onset groups, depending on clinical manifestations and the age at onset; group 1 (0-28 days; N = 10), group 2 (29 days-5 years; N = 13), and group 3 (greater than 5 years; N = 9). Compared to findings in the group 2 patients, there was a higher rate of mortality and a higher incidence of mental retardation in association with a great decrease in enzyme activity in group 1. In group 3, the mortality rate and enzyme activities were similar to those in group 1. However, patients in this group were asymptomatic prior to the first episode. Enzyme activities were measured mostly in autopsy samples. The serum citrulline levels (enzyme product) were highest in this group. Thus, the mutant enzymes were apparently labile with greater activities in vivo than in vitro. Treatments, including a protein-restricted diet, arginine supplementation, and sodium benzoate administration, resulted in a favorable prognosis for survivors with partial enzyme deficiency. We wish to emphasize that the incidence of late onset of this disease is higher than heretofore considered.

[Duodenal varices treated successfully by percutaneous transhepatic obliteration: report of a case]

A 73-year-old female with bleeding from duodenal varices treated by percutaneous transhepatic obliteration (PTO) was reported. She was admitted to our hospital because of tarry stool and general malaise. Gastroduodenoscopy revealed tortous elevations in the descending part of the duodenum, and observed intermittent bleeding. Percutaneous transhepatic portography (PTP) was carried out. PTP revealed duodenal varices supplied via the inferior pancreaticoduodenal vein and drained to the inferior vena cava, and continuously obliterated by gelfoam. Duodenal varices disappeared after obliteration and we observed no recurrence of varices for a year endoscopically. In general, it is accepted that the causes of the upper gastrointestinal bleeding secondary to portal hypertension are esophagogastric varices, hemorrhagic gastritis, gastro-duodenal ulcer, and so on. However, we must keep in mind the case with duodenal varices in which bleedings are of unknown origin. We also reviewed duodenal varices reported in Japanese literature from 1968 to 1989.

Low frequency of ras activation in 2-acetylaminofluorene- and 3'-methyl-4-(dimethylamino)azobenzene-induced rat hepatocellular carcinomas

Activation of ras protooncogenes in 11 2-acetylaminofluorene (AAF)-induced hepatocellular carcinomas (HCCs) or liver cell lines and 9 3'-methyl-(dimethylamino)azobenzene (3'-Me-DAB)-induced HCCs in rats was examined using the NIH3T3 cell transfection assay and oligonucleotide hybridization analysis. Only one cell line established from a AAF-treated rat liver demonstrated transforming activity with a point mutation and ATTA transversion at the second position of H-ras codon 61. The rates of ras activation were thus very low for both AAF- and 3'-Me-DAB-induced rat HCCs, the results thus extending and confirming the findings indicating that ras activation in rat HCCs induced by various type of carcinogens is infrequent.

In vitro progression-associated c-H-ras activation in neoplastic hepatocyte lines established from SV40-T antigen gene-harboring transgenic mice

In order to investigate the molecular mechanisms of multistep hepatocarcinogenesis in SV40-T antigen gene-harboring transgenic mice, 9 hepatocellular carcinoma (HCC) lines and 10 "preneoplastic" hepatocyte lines were established from the animals and their biological and molecular changes during culture were investigated. Three of the 9 HCC lines showed progression during culture in terms of growth rate and growth capability in soft agar and in nude mice. This progression was associated with the appearance of activated c-H-ras oncogene. Including these 3 lines, H-ras activation was observed in a total of 7 of the 9 HCC lines (78%), whereas it was found only in 1 of 10 (10%) "preneoplastic" hepatocyte lines. These data thus indicate that H-ras activation may be an event occurring at a relatively late stage of hepatocarcinogenesis in this transgenic mouse system and that it may serve towards completion of the carcinogenic process together with the T-antigen.

Allelotype study of primary hepatocellular carcinoma

Accumulation of mutations in oncogenes and tumor suppressor genes transforms a normal cell to a malignant cell by allowing it to escape from normal control of growth. In order to learn (a) how many tumor suppressor genes are involved in the tumor progression of hepatocellular carcinoma, (b) whether there is any association among allelic losses of chromosomes, or (c) whether integration of hepatitis B virus into host DNA influences any particular chromosomal losses, we have examined loss of heterozygosity with 44 restriction fragment length polymorphism markers in 46 cases of hepatocellular carcinoma. The markers represented all chromosomal arms except 5p, 8p, 9p, 18p, and acrocentric chromosomes. Allelic losses in tumors indicated that five tumor suppressor genes, located on chromosomes 5q, 10q, 11p, 16q, and 17p, may be involved in this cancer. However, no significant associations were observed among the various allelic losses or between the integration of hepatitis B virus and chromosomal losses. Furthermore, a deletion map for chromosome 16q indicated the localization of a tumor suppressor gene between q22 and q24 and that for chromosome 17p suggested the existence of a second tumor suppressor gene in addition to the p53 gene.

Autosomal recessive polycystic kidney in rats

We evaluated the characteristics of renal lesions in rat autosomal recessive polycystic kidney (ARPK). In rat ARPK, small cysts appeared primarily in the medulla 2 months after birth and gradually extended to the cortex, forming large cysts involving the entire layer after 8 months. By immunofluorescence microscopy, type IV collagen was more strongly stained in the epithelial basement membrane of the rat ARPK than in the normal rat tubular basement membrane (TBM). Electron microscopy demonstrated a marked thickening, slight splitting and lamination of the TBM in the ARPK. As peroxidase-labeled lectins, dolichos biflorus very strongly stained the cyst epithelium whereas lens culinaris did not. These findings indicate that cysts in rat ARPK originate in the collecting duct.

The use of N-(aminobenzoyloxy) succinimide as a two-level heterobifunctional agent for the preparation of hapten-protein conjugates. Daunomycin as a model hapten with an amino group

Three geometric ortho-, meta-, and para-isomers of N-(aminobenzoyloxy)succinimide (ABS) were synthesized, and their usefulness as a two-level heterobifunctional cross-linking agent in the preparation of hapten-protein conjugates was evaluated. The conjugation was based on the principle that ABS reacts immediately with an amino group of a hapten, and an aminobenzoyl group incorporated into the hapten is then activated by diazotization to a functional diazobenzoyl group acting on tyrosine or histidine residues of the protein. Using the anti-tumor antibiotic daunomycin (DM) as a model hapten, the three isomers of ABS were compared for their ability to conjugate DM with bovine serum albumin (BSA); DM incorporation onto a BSA molecular was found to occur to the highest degree with m-ABS, followed by p-ABS. while o-ABS completely failed to conjugate under the same coupling conditions. Using m-ABS it was possible to introduce more than 10 molecules of DM per BSA molecule. One of the DM-BSA samples was used as the immunogen for the production of anti-DM serum in a rabbit. The antibody specificity was shown to be direct to DM but not to other anti-cancer drugs (bleomycin, mitomycin C, actinomycin D and 5-fluorouracil) by the double antibody enzyme immunoassay (DEIA) using DM-beta-galactosidase conjugate as a label. An enzyme-linked immunosorbent assay (ELISA) for anti-DM IgG was developed using a DM-human serum albumin (DM-HSA) conjugate similarly prepared with m-ABS and horseradish peroxidase-conjugated goat anti-rabbit IgG as the solid-phase antigen and the labelled second antibody, respectively. This ELISA permitted us to measure accurately as little as 50 ng of anti-DM IgG per ml using a standard anti-DM IgG which had been purified from the anti-DM serum using an affinity column of Sepharose 4B with DM-HSA as the ligand. Using this ELISA as well as a sandwich enzyme immunoassay (SEIA) for total IgG, serum levels of anti-DM IgG and total IgG levels were easily monitored in a rabbit following immunization with DM-BSA. These results indicate that the use of DBS provides a novel method for preparing hapten-protein conjugates which will be useful in biochemistry and immunochemistry.

Screening system for asymptomatic renal disease in children in Japan

The introduction in Japan of routine urinalysis for pre-school and school age children has greatly facilitated the discovery of renal disease in asymptomatic children. Over the past 8 years at Kitasato University Hospital, we have studied 113 cases of chronic progressive renal disease based on renal biopsy. Thirty-one of these 113 patients were found by routine urinalysis at area schools. It is note-worthy that many of the asymptomatic children were found to have renal diseases such as MPGN, FGS, and IgA nephropathy. Although it is difficult to decide whether or not medical management is required for asymptomatic children, the histological findings may give pertinent guidance for planning an appropriate therapeutic program in the early stages of various types of renal disease. This early detection may enable us to observe these potentially progressive renal diseases from the early phase and to provide clues for the investigation of the pathogenesis of these renal diseases.

Descriptive epidemiology of non-insulin dependent diabetes mellitus detected by urine glucose screening in school children in Japan

During the period from 1974 through 1988, we annually examined approximately 225,000 to 386,400 school children residing in Tokyo for glycosuria to detect juvenile diabetes. If the first test was positive for glucose, glycosuria was confirmed by a second test. In children who gave a positive result in both the first and second tests 0-GTT were performed. All 124 patients were diagnosed as NIDDM according to the criteria of the WHO Report on Diabetes of 1985. The incidence of NIDDM in children in Japan has increased in recent years and from 1984 to 1986 was approximately 3.8 per 100,000 per year. The frequency of NIDDM increases with age up to 14 years. In about 84% of cases, the body weight at diagnosis is more than 20% above the ideal weight and the height is often above average. There is a high frequency in families with a history of diabetes. Diet and exercise therapy in newly diagnosed patients irrespective of the presence or absence of obesity may result in remission, but some cases may require insulin therapy or oral administration of a hypoglycemic drug to obtain a better glycemic control. Children with NIDDM are more likely to be complicated by incipient retinopathy within two years after diagnosis than those with IDDM. Therefore, it is important to keep strict glycemic control to prevent diabetic complications in NIDDM children just as in juvenile onset IDDM.

Determination of fluoride ion in animal bone by microdiffusion analysis

A microdiffusion analysis method for the determination of fluoride ion in animal bone sample was established by using a new diffusion cell. The cell is equipped with a water jacket to control the temperature. The space inside the cell is divided by a crossed-beam stand into top and bottom parts. In the bottom part, derivatization of fluoride ion to trimethylfluorosilane (TMFS) by hexamethyldisiloxane as the reagent occurs, with the volatile TMFS being absorbed into alkali placed in an open-top cup supported by the stand. The cell is placed on a magnetic stirrer to rotate the stirring bars in both reaction and absorption solutions. Stirring and elevation of temperature increase the reaction rates. Maintaining the cell at 40 degrees C for 3 h is sufficient for complete extraction of fluoride ion from the bone and its recovery. With our method, more than 10 micrograms/g of fluoride ion in bone can be assayed with a coefficient of variation of less than 3%. The fluoride levels of various rat bones were clarified.

Headaches in dementia

We investigated 288 elderly subjects with various degree of dementia, focusing on headaches. Seventy-three of 288 elderly subjects (25.3%) complained of some headaches. The most common type was the tension-type headache, from which 43 of the 73 subjects with headaches (58.9%) suffered. The degree of cognitive disturbances, evaluated by Hasegawa's intelligence scale, significantly correlated to the prevalence of headaches, and indicated that patients with dementia appeared to have less headaches. The methodological issues and views on headache research in dementia were assessed, and it is concluded that the field is a difficult one, with potential for error.

[Reconstructive surgery for supravalvular aortic stenosis after arterial switch operation for simple transposition in the early neonate]

Recently, many papers have reported the development of severe pulmonary stenosis after an arterial switch operation (ASO) for the transposition of the great arteries (TGA) with intact ventricular septum (IVS) in the early neonate. However, supravalvular aortic stenosis after the same procedure is very uncommon. We experienced supravalvular aortic stenosis which developed gradually after successfully performing the Lecompte maneuver for TGA with IVS in a 6-day-old baby. We underwent Doty's extended aortoplasty in his 11th-month. We approached the aorta through the transection of the pulmonary trunk which was located just before the aorta. At the stenotic parts of the aorta, a discrete projection of cicatricial tissue was observed mainly at the posterior wall. The projection of the cicatricial tissue seemed to be induced as a consequence of the contraction of the aortic wall where a continuous suture was tied too tightly with non-absorbable suture materials. To prevent this complication after the Lecompte maneuver for TGA with IVS in the neonate, it is important to take care not to tie the suture too tightly and to use absorbable suture materials for construction of the aorta. There are the recommendations which we observed would prevent the post-operative complication of supravalvular aortic stenosis. As a final note, in repairing the supravalvular aortic stenosis, an approach through the transection of the pulmonary trunk was very useful.

A case of coexisting malignant carcinoid tumor and adenocarcinoma in the papilla of Vater

A 47-year-old Japanese woman in whom obstructive jaundice had already been diagnosed, was found to have a dome-shaped elevated tumor approximately 3 cm in diameter located in the area very close to the papilla of Vater on endoscopical and radiographical investigations. Histopathologically, the resected tumor was composed mainly of solid nests of atypical argyrophilic cells, and partially of an area of well differentiated tubular adenocarcinoma, showing mutual transition in the mucosal layer. Both immunohistochemical and ultrastructural analyses confirmed the difference in character of tumor cells between these two areas: neuroendocrine cell carcinoma and tubular adenocarcinoma of common type in the intestine. To the best of our knowledge, this is only the third case reported to be a coexisting malignant carcinoid tumor and adenocarcinoma arising in the periampullary region.

Studies on the optimal immunization schedule of experimental animals. VI. Antigen dose-response of aluminum hydroxide-aided immunization and booster effect under low antigen dose

The dose-response relationships of a viomycin (VM) immunogen for total immunoglobulin (Ig) G and anti-VM antibody response of mouse using aluminum hydroxide as adjuvant was studied. The condition required to absorb a protein on aluminum gel was first established. The effective immunogen dose for total and specific IgG response of mouse using aluminum hydroxide as the adjuvant was found to be in the narrow range of 5 to 20 micrograms, and 10 micrograms per mouse was optimal. The most effective number and intervals of booster injections were studied; when mice were immunized with a lower antigen dose than the optimal, both the number and interval period of booster injections greatly affected the immune response; the more boosters were given, the higher was the response level of specific IgG. The results are contrary to those obtained by immunizing with the optimal or a higher antigen dose.

Observation of the Fe4+ = O stretching Raman band for cytochrome oxidase compound B at ambient temperature

Resonance Raman and visible absorption spectra were simultaneously observed for cytochrome oxidase reaction intermediates at 5 degrees C by using the artificial cardiovascular system (Ogura, T., Yoshikawa, S., and Kitagawa, T. (1989) Biochemistry 28, 8022-8027) and a device for Raman/absorption simultaneous measurements (Ogura, T., and Kitagawa, T. (1988) Rev. Sci. Instrum. 59, 1316-1320). The Fe4+ = O stretching (nu FeO) Raman band was observed at 788 cm-1 for compound B for the first time. This band showed the 16O/18O isotopic frequency shift (delta nu FeO) by 40 cm-1, in agreement with that for horseradish peroxidase compound II (nu FeO = 787 cm-1 and delta nu FeO = 34 cm-1). In the time region when the FeII-O2 stretching band for compound A and the nu FeO band for compound B were coexistent, a Raman band assignable to the Fe3+-O-O-Cu2+ linkage was not recognized.

Resonance Raman study on mutant cytochrome P-450 obtained by site-directed mutagenesis

Resonance Raman spectra were observed for the threonine-301 to serine or valine mutant as well as the wild type of rabbit liver microsomal cytochrome P-450 [laurate(omega-1)-hydroxylase] (P-450(omega-1], which were prepared through site-directed mutagenesis. The high-spin marker resonance Raman (RR) bands became similarly stronger for all the P-450s examined in the oxidized form upon addition of laurate, and the RR spectra in the higher frequency region of the oxidized, reduced and CO-adduct forms did not distinctly differ among the P-450s examined. Nevertheless, the Fe-CO stretching mode (vFe-CO) of the CO adduct exhibited an upshift for the valine mutant, suggesting positional proximity of Thr-301 to bound CO like Thr-252 of P-450cam, in agreement with the expectation from the sequence analysis. The vFe-CO band was shifted to higher frequency upon binding of normal alkyl fatty acids with C10 or longer alkyl chain but little affected by binding of shorter fatty acids.

Hereditary fructose intolerance caused by a nonsense mutation of the aldolase B gene

The nucleotide sequence of a patient's aldolase B gene was determined and showed a substitution of a single nucleotide (C----A) at position 720 in the coding region, which resulted in the 240th amino acid, a cysteine, being changed to a stop codon (TGC----TGA). By an allele-specific oligonucleotide probe and polymerase chain reaction, the patient was shown to be homozygous for the mutation. To examine whether this mutation causes functional defect of the enzyme, the activity of the aldolase B from the patient, expressed in Escherichia coli by using expression plasmid, was measured. No activity was observed, and the predicted product was recovered from E. coli expression plasmid, indicating that this nonsense mutation was the cause of aldolase B deficiency.

Development of transgenic mice containing woodchuck hepatitis virus DNA

We produced transgenic mice containing woodchuck hepatitis virus DNA with tandem repeat structure capable of producing virus and viral antigens. Poly(A)+ RNAs probably corresponding to pregenome and viral antigens were detected in their liver. These mice have now been healthy for one year. However, there is the possibility of inducing immunologically mediated hepatitis. We anticipate these transgenic mice may present a useful model system for studying the significance of chronic hepatitis in hepatocellular carcinoma development.

Cytotoxic effects of aflatoxin B1 and its association with cellular components in chicken embryo primary cultured cells

We have examined the cytotoxicity and cellular incorporation of aflatoxin B1 (AFB1) in several types of established and primary cultured cells. The inhibition of DNA synthesis by AFB1 at 1 microgram/ml was about 0-30% in the established cell lines, including human hepatic cells. In chicken primary hepatocytes, however, DNA synthesis as well as RNA and protein syntheses were strongly inhibited by much lower concentrations of AFB1, e.g., 0.1 microgram/ml. In contrast, chicken primary fibroblasts showed almost no significant response to the toxin. Microsomal cytochrome P-450 activities in hepatic tissues were 10-20-fold higher than those in fibroblastic tissues. The amount of [3H]AFB1 incorporated into acid-insoluble materials in the primary hepatocytes was also 10-100-fold more than that in the primary fibroblasts. However, a significant amount of AFB1, which was enough to induce cytotoxic effects on the primary hepatocytes, could be incorporated into the primary fibroblasts when the concentrations of AFB1 were increased. Characterization of the AFB1-associated cellular components showed that most of them were DNA, RNA, and proteins in the primary hepatocytes, while in the primary fibroblasts a large portion of the incorporated AFB1 was recovered from lipid fractions. In addition, the selective binding of [3H]AFB1 to several proteins was observed only in the primary hepatocytes. The possible role of the AFB1-binding proteins are also discussed.

Detection of activated c-H-ras oncogene in hepatocellular carcinomas developing in transgenic mice harboring albumin promoter-regulated simian virus 40 gene

Hepatocellular carcinomas (HCCs) developing in transgenic mice harboring an albumin promoter-regulated simian virus 40 (SV40) tumor antigen gene were analyzed for activating point mutations of the c-H-ras oncogene. Oligonucleotide hybridization studies utilizing enzymatically amplified DNA sequences of paraffin-embedded tumor tissues revealed that 10 out of 25 HCCs contained either an A-to-T or an A-to-G conversion at the second position of codon 61. Northern blot studies confirmed expression of SV40 gene mRNAs in the tumor tissues of both mutation-positive and mutation-negative HCCs. These findings in association with earlier results thus strongly suggest that mutational activation of cellular oncogene may play an important role in SV40-initiated multistage hepatocarcinogenesis in vivo.

Portions of basement membrane with decreased negative charge in various glomerulonephritis

The decrease in negative charge was evaluated in different portions of the basement membrane as well as the lamina rara externa (LRE) and lamina rara interna (LRI). The subjects were nine patients [2 patients with focal segmental glomerulosclerosis (FGS), 2 with membranoproliferative glomerulonephritis (MPGN), 3 with IgA nephropathy, and 2 with Henoch-Schoenlein purpura nephritis (HSPN)] and 2 patients with minor glomerular abnormalities and 1 with tubulo-interstitial nephritis (TIN) as controls. Polyethyleneimine (PEI) was used as a cationic probe. The basement membrane was divided into the peripheral portion (loop basement membrane 7 microns or more from the anchor portion), proximal portion (within 3 microns of the anchor portion), and the paramesangial portion in the paramesangial basement membrane. In each portion, PEI granules per 1 micron of the LRE and LRI were counted. Anionic sites were decreased in the patients with FGS and MPGN, but the damage pattern differed between the two diseases. In the patients with FGS, the decrease in anionic sites was most marked in the peripheral portion with an even greater decrease in the LRI. In the patients with MPGN, the decrease was uniform among the portions. On the other hand, no significant difference was observed in any portion between the patients with IgA nephropathy or HSPN and the controls. The portions with decreased negative charge varied among various glomerular diseases, suggesting different developmental mechanisms.

Studies on the optimal immunization schedule of experimental animals. V. The effects of the route of injection, the content of Mycobacteria in Freund's adjuvant and the emulsifying antigen

The effects of several conditions for the immunization of mice was studied using an aliquot of a viomycin (VM) protein conjugate as the common primary or booster antigen. Responses of the mice were assessed by measuring mouse serum levels of total immunoglobulin G (IgG) and anti-VM antibody responses using the newly improved two assay methods. The choice of route was found to be a very important factor in immunization and intraperitoneal injection was the most optimal among the four routes studied. The effect of the concentration of Mycobacteria in Freund's complete adjuvant (FCA) was also studied, and it was found that a diluted FCA was more effective than a commercial FCA. The effect of the controlled release of the antigen was studied and three important phenomena were observed: The mice immunized by the mini-osmotic pump-aided controlled release of the antigen responded with similar small amounts of both total IgG and anti-VM antibody regardless of the presence or absence of FCA in the antigen; emulsifying the antigen with FCA was a very important condition for the effective elicitation of the specific antibody; a mixture of antigen and FCA without emulsifying produced little specific antibody and a large amount of total IgG. The more effectively immunized mice responded with a larger decrease in body weight soon after the primary injection.