Overexpression of HLA class I antigen reduces insulin secretion in pancreatic beta cells (RINM5F): evidence for a non-immune mechanism

Our recent observation indicated that overexpression of HLA-class I antigen on pancreatic beta cells is one of the features of insulin-dependent diabetes mellitus (IDDM). To analyze the effect of class I antigen overexpression, we have introduced human HLA class I (HLA-Cw3) gene into rat pancreatic beta cell lines, RINm5F. Several stable transformants with various levels of surface expression of class I antigens have been cloned. The insulin secretion of these transfectants was analyzed to evaluate the functions of beta cells. Highly negative correlation between the level of insulin secretion and that of class I expression (correlation coefficiency: r = 0.89) has been observed. These data suggest that the overexpression of HLA class I antigen itself may impair pancreatic beta cells through a nonimmune mechanism.

Trimethadione tolerance tests for the assessment of feasible size of hepatic resection in patients with hepatocellular carcinoma

Pre-operative evaluation of the quantity of functional remnant hepatic parenchyma after hepatectomy was carried out to predict the optimal amount of hepatic resection using the trimethadione (TMO) tolerance test. This test is an estimate based on serum diamethadione (DMO)/TMO ratio (DMO is the only metabolite of TMO) 4 h after oral administration of TMO, and computed tomography (CT) scans of the liver in patients with hepatocellular carcinoma (HCC). The percentage of remnant hepatic parenchyma was calculated pre-operatively from the remaining non-cancerous portion and the whole hepatic parenchyma, excluding the HCC portion, using the CT scans. Presumptive remnant DMO/TMO ratio was calculated by multiplying the percentage of remnant hepatic parenchyma and pre-operative serum DMO/TMO ratio in 45 patients with HCC undergoing resection. The presumptive remnant DMO/TMO ratios were 0.31 +/- 0.10 (mean +/- s.d.) in 42 patients who survived hepatectomy and 0.13 +/- 0.02 (below 0.15) in the three patients who died from postoperative hepatic failure. Of these surviving patients, two patients who had the presumptive remnant DMO/TMO ratios under 0.15 developed postoperative severe complications. Thus, hepatectomy may not be indicated in patients where presumptive remnant DMO/TMO ratio is 0.15 and lower. These findings suggest that pre-operative measurement of presumptive remnant DMO/TMO ratio, when obtained with the CT of the liver and TMO tolerance test, is useful for prediction of the quantity of functional remnant hepatic parenchyma after hepatectomy in patients with chronic liver disease.

The HLA-DR and DQ genes control the autoimmune response to DNA topoisomerase I in systemic sclerosis (scleroderma)

HLA class II alleles were determined using the PCR-RFLP method in Japanese systemic sclerosis (scleroderma) patients with (n = 28) or without (n = 34) anti-topoisomerase I antibodies (anti-topo I). Either the DQB1*0601 or *0301 allele was recognized in all anti-topo I positive patients, compared with 44% of anti-topo I negative patients (P < 0.00001, relative risk [RR] > 41) or 58% of Japanese healthy control subjects (P < 0.00001, RR > 24). Tyrosine at position 26 in the second hypervariable region in the beta 1 domain of the DQB1 gene is common to these two alleles and is not present in any other known DQB1 alleles. We also examined immunoreactivities of anti-topo I positive sera to four different autoantigenic B cell epitopes of topo I molecule that were expressed as recombinant fusion proteins. One major B cell epitope, located within the region corresponding to amino acid residues 74-248, was perfectly associated with the amino acid sequence FLEDR at positions 67-71 in the beta 1 domain of the DRB gene. Two other epitopes, corresponding to 316-441 or 658-700, were associated with the serologically defined HLA-DR52 antigen. Patients with both FLEDR and DR52 demonstrated higher anti-topo I antibody titers. These results suggest that the HLA-DR and DQ genes together control the autoimmune response to topo I in systemic sclerosis.

Apparent genetic difference between hypothyroid patients with blocking-type thyrotropin receptor antibody and those without, as shown by restriction fragment length polymorphism analyses of HLA-DP loci

HLA types in Japanese patients with primary hypothyroidism were analyzed to see whether those with blocking-type TSH receptor antibody (TSH-R BAb M) differed genetically from those with idiopathic myxedema (IM). HLA typings of -A, -B, -C, -DR, and -DQ (73 antigens) were performed serologically, and those of -D and -DP (29 antigens) were analyzed by the restriction fragment length polymorphism method. Thirty patients were studied with TSH-R BAb M, and 28 with IM. The data were analyzed and compared with our previous results from 88 Graves' patients, 46 Hashimoto patients, and 186 control subjects. Overall, 192 patients with 4 autoimmune thyroid disorders showed a decrease in -Aw19 and an increase in -DQw4 (corrected P < 0.05) and significant associations of -Aw33, -Bw46, -Cw3, -DRw8, -DR9, and -DQw3. In TSH-R BAb M patients, increases in -B35, -Bw60, and -Dw8 and decreases in -DR4 and -DPw2 were seen, whereas IM patients showed increased -DPw2, -Bw61, and -Dw23. In comparisons between TSH-R BAb M and IM, the difference in -DPw2 was highly significant. HLA-B35 differed significantly in these 2 types of hypothyroidism. In conclusion, TSH-R BAb M patients have decreased frequency of -DPw2 and are genetically similar to Graves' disease, whereas IM patients are characterized by high frequency of -DPw2 and are genetically similar to Hashimoto's thyroiditis.

[Urgent mitral valve replacement for acute mitral regurgitation due to ruptured chordae tendineae in systemic lupus erythematousus]

We reported a successful surgical treatment of mitral regurgitation (MR) due to ruptured chordae tendineae in a 44-year-old man with systemic lupus erythematosus (SLE) who had received the steroid therapy. He had signs of acute congestive heart failure with severe pulmonary hypertension due to MR, and underwent urgent mitral valve replacement. The postoperative course was uneventful. When replacing valve in SLE, a careful manipulation should be taken because of friability of cardiovascular tissue. Patients are usually administered steroid agents, and the agents ought to be discontinued in perioperative period, but it seems to be better to resume as soon as possible. We conclude that the surgical treatment for valvular diseases should be considered, even in the patient with SLE.

Modulation of aflatoxin B1-induced glutathione S-transferase placental form positive hepatic foci by pretreatment of rats with phenobarbital and buthionine sulfoximine

Induction of glutathione S-transferase placental form (GST-P) positive hepatic foci has been examined by immunohistochemical analysis in young male Fischer rats 3 weeks after a single i.p. injection of aflatoxin B1 (AFB1). Pretreatment of rats with L-buthionine sulfoximine (BSO), a GSH depleter, at a dose of 4 mmol/kg body wt 4 and 2 h before 1.0 mg AFB1 treatment enhanced both the number of AFB1-induced hepatic foci and the area occupied by these foci by approximately 400 and 575% above their respective controls without affecting the mean diameter of these foci. Pretreatment of rats with 0.1% phenobarbital (PB) in their drinking water for 1 week before AFB1 (1 mg) treatment, inhibited AFB1-induced foci almost completely. However, the number of AFB1-induced foci in PB-pretreated rats was not significantly increased by BSO pretreatment.

Steroid hormones protect spinal cord neurons from glutamate toxicity

The effects of steroid hormones on glutamate neurotoxicity were examined in cultured spinal cord neurons. The extent of neuronal damage, produced by glutamate exposure for 15 min, was estimated based on the activity of lactate dehydrogenase released from degenerated neurons to the media during 24 h of post-exposure incubation. This damage was dependent on the glutamate concentrations used. The addition of dexamethasone, a synthetic steroid, in post-exposure media remarkably reduced the extent of damage in a dose-dependent manner. The half effective concentration for the steroid was approximately 0.7 microM, which was in the range of pharmacological concentration. Dexamethasone was effective even when it was added 2 h after glutamate exposure. Some endogenous steroid hormones--aldosterone, progesterone and testosterone--also showed similar neuroprotective effects. However, cholesterol, a precursor of these steroid hormones, had no effect on glutamate neurotoxicity. This direct protective effect on neurons against glutamate neurotoxicity may explain, at least partly, the mechanisms of beneficial effects of steroid hormones on in vivo spinal cord injury.

Association of HLA-A24 with complete beta-cell destruction in IDDM

A sensitive C-peptide immunoreactivity radioimmunoassay demonstrated the presence of subtle, but definite residual beta-cell function in patients with IDDM of long duration. Although HLA antigens are known to influence susceptibility to IDDM, their contribution to the extent of pancreatic beta-cell destruction has not yet been examined extensively. We studied the relationship between residual beta-cell function and HLA class I and class II antigens in 111 unrelated Japanese IDDM patients. Using the sensitive C-peptide immunoreactivity radioimmunoassay, the presence or absence of residual beta-cell function was evaluated by the C-peptide immunoreactivity response to a 100-g oral glucose load. DNA typing for HLA-DQA1 and HLA-DQB1 antigens was performed in addition to serological typing of HLA-A, HLA-B, HLA-C, and HLA-DR antigens. A C-peptide immunoreactivity response > 0.033 nM was regarded as an indication of the presence of residual beta-cell function, not the assay error. Surprisingly, 35 of 37 (94.6%) patients without residual beta-cell function had HLA-A24, whereas only 39 of 74 (52.7%) patients with residual beta-cell function had this antigen (corrected P = 9.795 x 10(-6). Any other HLA antigens, including the DR and DQ loci, showed no difference in the frequency with regard to residual beta-cell function. The duration of diabetes was similar between the groups with and without residual beta-cell function.(ABSTRACT TRUNCATED AT 250 WORDS)

Protothecosis in a patient with systemic lupus erythematosus

A rare case of protothecosis in a 40-year-old Japanese woman with systemic lupus erythematosus, under long-term prednisolone treatment is presented. The patient developed extensive ulcerative skin lesions after injury. The characteristic histopathological findings and biochemical sugar assimilation tests indicated infection by Prototheca wicherhamii. The lesions improved following treatment with amphotericin B. The immunodeficient state of this patient seemed to contribute to the infection with Prototheca.

Reproductive risk in mating between two translocation carriers: case report and review of the literature

We conducted a study to determine the reproductive risk in a couple who were translocation carriers. This couple, who carried balanced reciprocal translocations, experienced habitual abortions. The wife had a karyotype of 46,XX,t(7;13)(p15.3;q12.3) and the husband of 46,XY,t(1;7)(p11.1;p11.1). Chromosome study of their fourth abortus demonstrated a chimera consisting of two cell lines with a 46,XY and a 46,XX,t(1;7)(p11.1;p11.1)pat, -13, + der(7)t(7;13)(p15.3;q12.3)mat, karyotype. A review of the literature indicates that the risk of having unbalanced live offspring or of spontaneous abortion/stillborns is similar in couples in whom both were translocation carriers and in couples in whom one individual was a translocation carrier. The apparent lack of increased reproductive failure may result from the selective disadvantage of aneusomic gametes at fertilization or very early spontaneous abortions of unbalanced conceptuses.

Clinical significance of serum soluble HLA class I antigens in systemic lupus erythematosus

Serum soluble HLA (SHLA) class I antigens in patients with systemic lupus erythematosus (SLE) were examined by enzyme-linked immunosorbent assay. The primary antibody used was W6/32, anti-HLA class I mouse monoclonal antibody, and the secondary antibody was peroxidase-conjugated anti-mouse IgG antibody. The reactivity of SHLA class I antigens, the number of peripheral lymphocytes, and the clinical state of SLE were compared. The results were as follows; 1) Sixteen of 55 samples from SLE patients were SHLA class I antigen-positive (29%). 2) The reactivity of SHLA class I antigens was closely related to disease activity. 3) The number of lymphocytes and the reactivity of SHLA class I antigens were negatively correlated. 4) Nine of 23 samples from the active SLE patients were SHLA class I antigen-negative. Of these, 7 were from patients with a nephrotic syndrome due to lupus nephritis. It is concluded that SHLA class I antigens can be an useful marker for monitoring the clinical state of SLE.

Non-obstructive hypertrophic cardiomyopathy with mitral regurgitation requiring valve replacement

Non-obstructive hypertrophic cardiomyopathy (HCM) is rarely associated with mitral regurgitation severe enough to require valve replacement. A 39-year-old man, previously diagnosed as having non-obstructive HCM with mitral regurgitation, developed atrial fibrillation with tachycardia and congestive heart failure. Echocardiography and cardiac catheterization, including left ventriculography, documented an unusual type of non-obstructive HCM with severe mitral regurgitation. The patient underwent successful mitral valve replacement.

[Can ulinastatin be an effective inhibitor of human polymorphonuclear granulocyte elastase under severe stressed state?]

The inhibitory effect of ulinastatin (UST), an intrinsic human trypsin inhibitor was investigated on the activity of polymorphonuclear granulocyte elastase (PMNE) with or without alpha 1-protease inhibitor (alpha 1-PI) using the in vitro models. The results of the dodecyl-sulfate-electrophoresis (SDS-PAGE), indicated that splitting-action of crude granulocyte enzyme solution on the plasma fibronectin was inhibited by concentration-dependent UST of an equivalent value for treatment of stressed state. The PMNE-UST complex was competitively replaced by PMNE-alpha 1-PI complex in vitro models of inflammatory focus and circulation, hence UST was weaker than alpha 1-PI in its binding-affinity for PMNE. The PMNE activity was directly inhibited by UST in the inflammatory focus and circulation with or without alpha 1-PI.

Intraductal papillary neoplasms of the pancreas: diagnosis by endoscopic pancreatic biopsy

Intraductal papillary neoplasms of the pancreas (IPN) are rare tumors, distinct from other pancreatic duct cell carcinomas both in terms of papillary polyp formation in the main pancreatic duct and their favorable prognosis. In the present study, endoscopic pancreatic biopsy (EPB) under fluoroscopic control was employed in three cases of IPN to obtain a tissue diagnosis prior to surgery. There were no complications and all biopsy specimens were adequate for histopathological evaluation. In our experience, EPB is a simple, safe and effective method, yielding sufficient material for preoperative tissue diagnosis of pancreatic tumors, especially in the case of IPN.

Studies on antiinflammatory agents. II. Synthesis and pharmacological properties of 2'-(phenylthio)methanesulfonanilides and related derivatives

The structure of the previously reported new antiinflammatory agent (1, FK3311) was chemically modified in an attempt to find novel compounds with more potent and broader-spectrum activities. Some 2'-(phenylthio) and 2'-(phenylamino)methanesulfonanilides (2 and 3), in particular those bearing an electron-attracting substituent at the 4'-position, potently inhibited adjuvant arthritis in rats as well as collagen-induced arthritis in mice when administered orally. 4'-Carbamoyl-2'-(2,4-difluorophenylthio)methanesulfonanilide (3b), which was selected as a candidate for further development from among the compounds synthesized herein, exhibited activity in reducing arthritis in a spontaneous autoimmune disease model (MRL/lpr mice) within the dose range of 10-100 mg/kg (p.o.).

[Expression of LFA-1 and ICAM-1 on peripheral blood T-cells and soluble CD2 levels in serum during acute Kawasaki disease]

To clarify the activation of peripheral blood T-cells in Kawasaki Disease (KD) patients, we investigated whether the expression of lymphocyte function-associated antigen-1 (LFA-1) and/or intercellular adhesion molecule-1 (ICAM-1) on peripheral blood T-cells and serum levels of soluble CD2 (sCD2) increase during the acute stage. Expression of cellular adhesion molecules was analyzed using flow cytometry. sCD2 levels in serum were measured by a sandwich enzyme immunoassay. There was a decrease in the number of CD3+ T-cells in the bright LFA-1 alpha and LFA-1 beta population and a concomitant increase in the dim population of LFA-1 alpha and LFA-1 beta during the acute stage, in comparison with the convalescent stage. In addition, we observed no significant differences in ICAM-1 expression between the acute stage and the convalescent stage. There were no significant differences in sCD2 levels among the acute stage, the convalescent stage and the control subjects. In our view the present data, in conjunction with previous reports on T-cell function during acute KD, suggest that sequestration of activated peripheral blood T-cells may be a feature of this disease.

Modification of the amino group of guanosine by methylglyoxal and other alpha-ketoaldehydes in the presence of hydrogen peroxide

Methylglyoxal is directly mutagenic to Salmonella typhimurium TA100 and its mutagenicity is markedly enhanced in the presence of hydrogen peroxide. We found that methylglyoxal in phosphate buffer was decomposed easily by hydrogen peroxide at room temperature to yield acetic acid and formic acid as major products and diacetyl as a minor product; acetyl radical was detected in the solution by ESR spectroscopy by the use of a spin-trapping reagent, 5,5-dimethyl-1-pyrroline N-oxide. Furthermore, guanosine was converted into N2-acetylguanosine by a combination of methylglyoxal and hydrogen peroxide in 0.1 M phosphate buffers (pH 6.1 to 7.4). This acetylation may be related to the enhancement of methylglyoxal mutagenicity by hydrogen peroxide. Other alpha-ketoaldehydes such as glyoxal and phenylglyoxal also yielded the corresponding acids and alpha-dicarbonyls upon reaction with hydrogen peroxide under the same conditions as above. These acids would have been produced through Baeyer-Villiger reaction or coupling of acyl radical with hydroxy radical, and dicarbonyls by dimerization of acyl radicals. In addition, when phenylglyoxal was used, the generation of benzoyl radical and the conversion of guanosine to N2-benzoylguanosine were observed. However, it remains to be established whether the generation of acyl radicals is directly involved in the N-2 acylation of guanosine.

[Evaluation of the combination of chemotherapy with etoposide, adriamycin and cisplatin (EAP) in advanced or recurrent gastric cancer]

EAP therapy was performed on 30 cases of advanced or recurrent gastric cancer between September 1987 and July 1991. The clinical responses of 15 trial patients were evaluated. The overall response rate was 40.0% (CR, one case; PR 5 cases). The results were thus not as favorable as that reported by Preusser et al. On the contrary, with such a poor response rate, this treatment did not lead to a prolonged life span (mean survival time; 5.6 months, median survival time; 4 months). Side effects, such as myelosuppression, appetite loss, nausea, vomiting, liver dysfunction, renal dysfunction, and alopecia, were also observed. Myelosuppression was a dose-limiting factor. The rhG-CSF proved in 4 cases to be a clinically useful tool against the neutropenia induced by this treatment. It may be concluded that EAP should be given to the following selected patients: (1) those whose condition is not so far advanced: (2) those who have not received many other forms of treatment; and (3) those in excellent general physical condition.

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

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

Kainic acid injection into medullary raphe produces gastric lesions through the vagal system in rats

There is little evidence of a role of nuclei in the brain stem, other than the dorsal motor nucleus of the vagus nerve in the medulla oblongata, in terms of central mechanisms for gastric ulcer formation. Recent reports suggest that the medullary raphe nuclei may be involved in the central regulation of gastric functions such as gastric acid secretion and motility. In the present study, we examined whether neurons in the nucleus raphe obscurus (NRO) played a significant role in the formation of gastric ulcers with the use of Sprague-Dawley rats. First, we determined whether excitation of the medullary raphe resulted in the development of gastric lesions. Chemical stimulation of neurons in the NRO by kainic acid produced gastric erosions within 4 h in 24-h fasted rats. Saline tested under the same conditions did not modify the integrity of the gastric mucosa. It was also demonstrated that kainic acid injection outside the raphe obscurus boundaries failed to develop gastric lesions. Next, we examined the effects of the vagal system on the gastric lesion formation induced by stimulation of the raphe nucleus. Bilateral gastric branch vagotomies completely prevented the development of the raphe nucleus-provoked gastric mucosal damage. All these results suggest, for the first time, that excitation of neurons in the medullary raphe obscurus induces gastric ulceration through vagal stimulation.

Transient depletion of T cells with bright CD11a/CD18 expression from peripheral circulation during acute Kawasaki disease

To clarify the activation of peripheral blood T cells in Kawasaki disease (KD) patients, we investigated whether expression of lymphocyte function-associated antigen-1 (LFA-1, CD11a/CD18) and/or intercellular adhesion molecule-1 (ICAM-1, CD54) on peripheral blood T cells increases during the acute stage. Expression of cellular adhesion molecules was measured using flow cytometry. There was a decrease in the percentage of CD3+ T cells in the bright LFA-1 alpha and LFA-1 beta population and a concomitant increase in the dim population of LFA-1 alpha and LFA-1 beta during the acute stage, in comparison with those of the convalescent stage. In addition, we observed no significant differences in ICAM-1 expression during the acute stage compared with that of the convalescent stage. In our view the present data, in conjunction with previous reports on T-cell function during acute KD, suggest that activated T cells are temporarily withdrawn from peripheral circulation during acute KD.

Intramural rupture of the esophagus: a rare complication associated with nasobiliary catheter placement

Intramural rupture of the esophagus developed after short-term nasobiliary catheter placement in an 87-year-old female with choledocholithiasis and suppurative cholangitis. Endoscopy revealed bleeding accompanied by circumferential disruption of the mucosa along the lower third of the esophagus. Withdrawal of the catheter and conservative treatment resulted in recovery of the lesion and relief of symptoms. This rare complication should be kept in mind during the placement of nasobiliary catheter.