Significance of interleukin 6 in patients with sarcoidosis

Interleukin 6 (IL-6) levels in various materials from patients with sarcoidosis were determined. The subjects of the study were 38 patients with sarcoidosis and 28 healthy controls. For detection of IL-6, an enzyme-linked immunosorbent assay method was used. Interleukin 6 activity in serum was detected in 4 of 30 patients, but not in 19 controls. In bronchoalveolar lavage (BAL) fluid, following 20-fold concentration, IL-6 activity was detected in four of ten patients (nonsmokers) and three of seven controls (two of two smokers and one of five nonsmokers). Interleukin 6 levels in the supernatants of cultured monocytes and alveolar macrophages (AMs) were significantly higher (p < 0.01 and p < 0.01, respectively) in patients with sarcoidosis than in controls. Interleukin 6 production from monocytes tended to correlate with that from AMs. A significant correlation (r = 0.70, p < 0.05) was found between IL-6 production from AMs and the ratio of CD4+/CD8+ in BAL fluid, although no correlation was observed between that from monocytes and CD4+/CD8+ ratio in BAL fluid. Taken together, IL-6 may be involved in the initiation and maintenance of alveolitis by activating and causing the proliferation of T cells.

[Penetration of the esophageal and gastric ulcers to the cardioaortic system following hiatus hernia: a lethal complication in the severely-handicapped]

Among the severely-handicapped, hiatus hernia (HH) and/or gastroesophageal regurgitation (GER) are not uncommon. We report here three patients with HH and/or GER. Two of them died of massive hemorrhage in the alimentary tract from the heart or the thoracic aorta due to penetration of the gastric or esophageal ulcer. The third patient died of pneumonia, but autopsy proved multiple esophageal ulcers, one of which reached the wall of the brachiocephalic artery without penetration. We propose that proper treatment for HH and/or GER is required for the severely-handicapped, including surgical intervention, before their general conditions become worse and decompensatory.

Monoclonal proliferation of double-negative (CD4-CD8-) T-cells bearing T-cell receptor-alpha beta followed by subsequent development of Hodgkin's disease

Expression of CD4 or CD8 on the cell surface is an important guide for discriminating the immunologic functions of T-cells. However, a minor T-cell subset lacking both CD4 and CD8 molecules but bearing the usual form of T-cell receptor (TCR)-alpha beta (CD4-CD8-TCR-alpha beta+ T-cells) has recently been found not only in mice but also in humans, and the clinical relevance of this newly defined subpopulation to human diseases is now of considerable interest. The authors present a patient in whom CD4-CD8-TCR-alpha beta+ T-cells showed monoclonal proliferation in the peripheral blood for more than 3 years, then disappeared spontaneously, followed by subsequent development of Hodgkin's disease. The pathologic roles of double-negative T-cell proliferation in this case are discussed from the viewpoint of premalignancy in lymphoproliferative diseases.

[The prevalence and significance of abnormal thyroid hormone metabolism in acute myocardial infarction]

In order to clarify the relationship between thyroid function and left ventricular function in acute myocardial infarction (AMI), 52 patients (63.3 +/- 11.0 years old) admitted to the coronary care unit within 24 hours after the onset were studied. Both FT3 and FT4 levels measured at 48-72 h after the onset (1.66 +/- 0.59 pg/ml, 1.02 +/- 0.37 ng/dl) were significantly lower than those on admission (2.99 +/- 0.76 pg/ml; p < 0.01, 1.14 +/- 0.25 ng/dl; p < 0.05) and controls (3.27 +/- 0.66 pg/ml; p < 0.01, 1.22 +/- 0.23 ng/dl; p < 0.05). The decline of these thyroid hormone levels correlated well with the severity of AMI (Killip's classification), hemodynamic deterioration and liver function (low levels of albumin and cholinesterase). Low thyroid hormone levels were also associated with the elevation of catecholamine and alpha-hANP levels on admission. Low cortisol and impaired renal function were recognized as factors which might prolong the condition of low thyroid hormones. Non-survivors showed significantly lower levels of FT3 and FT4 48 hours after onset, and a lower level of FT4 in aged patients was consistent with a poor prognosis. In conclusion, the measurement of thyroid hormones in AMI is important in evaluating the severity of the condition and waking a prognosis.

Abundant existence of 40kD-cdc2-related protein in rat thyroid cells

The cdc2 kinase family is known to be one of the important factors for cell proliferation in both yeast and mammalian cells. By using polyclonal antibodies against PSTAIRE region of cdc2HS, we studied the amount of cdc2-related kinases in the rat thyroid cell line, FRTL-5, during the cell cycle. The immunoreactive protein with molecular weight 34kD was hardly detectable, instead, 40kD protein exists constantly in amount through G0 phase to S phase. Further, it did not decrease when the cells were cultured in serum- and hormone-free medium. Moreover, we observed an increase of this protein in the nuclear fraction as the cells enter S phase. On the contrary, we could not detect any immunoreactive 40kD protein in primary cultures of rat thyroid cells. These results may indicate abundant existence of this protein might concern cell cycle regulation of FRTL-5 or its immortal feature.

Platelets-induced stimulation of endothelin-1 production and inhibition by phosphoramidon

The effects of platelets on endothelin-1 (ET-1) production were examined by using cultured bovine pulmonary artery endothelial cells (ECs). Platelets (6 x 10(6) to 2 x 10(9) platelets/ml) prepared from rat peripheral arterial blood markedly stimulated immunoreactive (IR)-ET release from ECs into the culture medium, in a time-and platelet number-dependent manner. High-performance liquid chromatography analysis of the culture supernatant following exposure to platelets revealed one major IR-ET component corresponding to the elution position of synthetic ET-1. Northern blot analysis showed that platelets enhanced prepro ET-1 mRNA expression in the ECs. Increased IR-ET release was observed with the supernatant obtained after incubation of platelets, and this increment was significantly inhibited by transforming growth factor-beta 1 neutralizing antibody. Phosphoramidon, an ET converting enzyme inhibitor, significantly decreased the amount of IR-ET accumulating in the culture medium of ECs, incubated with or without platelets, and the decreasing effect of phosphoramidon in the presence of platelets was greater than that in their absence. A similar effectiveness of phosphoramidon was seen when transforming growth factor-beta 1 was used instead of platelets. Thus, platelets appear to stimulate the endothelial production of ET-1 in vitro, probably through a release of transforming growth factor-beta 1. We also suggest that the inhibition of ET converting enzyme by phosphoramidon is more effective in the augmented condition of ET-1 production than in the basal condition.

Phorbol ester inhibits DNA synthesis induced by interleukin-6 in TSH-pretreated FRTL-5 cells

Combination of TSH and Interleukin-6 (IL-6) can stimulate DNA synthesis in FRTL-5 cells. Phorbol 12-myristate 13-acetate (PMA) stimulates G0 to G1 transition but inhibits G1 to S transition in these cells. We studied the effect of IL-6 on DNA synthesis in TSH-pretreated FRTL-5 cells in the presence or absence of PMA. IL-6 induced DNA synthesis when it was added to TSH-pretreated cells. Further, PMA inhibited the DNA synthesis induced by IL-6. These data might suggest that in FRTL-5 cells IL-6 can show its mitogenic effect in G1 phase of their cell cycle progression.

Acute, subchronic and chronic toxicity studies of a synthetic antioxidant, 2,2'-methylenebis(4-methyl-6-tert-butylphenol) in rats

General toxicity studies on 2,2'-methylenebis(4-methyl-6-tert-butylphenol) (MBMBP) were conducted using male and female Wistar rats. LD50 values were greater than 5 g/kg BW by oral administration for both sexes. Diarrhea was observed until 5 days. In the subchronic test, rats were fed diet containing MBMBP at 0, 0.12, 0.6 or 3.0% for 12 weeks. Severe suppression of body weight gain was observed in both sexes of 0.6 and 3.0% groups. Death accompanied by hemorrhage from nasal cavity was observed in 0.6 and 3.0% males and 3.0% females. Dose-dependent toxicity to the liver in both sexes was observed in blood chemical analysis. Histopathologically, testicular atrophy and decrease of spermatogenesis were dose- and time-dependently observed in all treated males. Atrophy of ovaries was evident in 0.6 and 3.0% females. Thymus atrophy and bone marrow hypoplasia were observed in both sexes of 0.6 and 3.0% groups. In the chronic test, rats were fed diet containing MBMBP at 0, 0.01, 0.03 and 0.1% for 18 months. Body weight gain was only suppressed in both sexes receiving 0.1%. Histopathologically, testicular atrophy and decrease of spermatogenesis were apparent in 0.1% males. No neoplastic response by MBMBP administration was noted. NOAEL was concluded to be 0.03% in the diet (12.7 mg/kg BW/day for male rats and 15.1 mg/kg BW/day for female rats).

Binding of lysozyme to lipopolysaccharide suppresses tumor necrosis factor production in vivo

Endotoxin (lipopolysaccharide [LPS]) released during gram-negative bacterial infection induces varieties of cytokines which directly and/or indirectly cause shock, disseminated intravascular coagulation, and death. We previously showed that lysozyme (LZM) was an LPS-binding protein and inhibited various immunomodulating activities of LPS. In this study, we examined the effect of LZM on the LPS-triggered septic shock model induced by carrageenan treatment and assessed by tumor necrosis factor production. The data presented in this report strongly suggest that LZM-LPS complex formation completely abrogates tumor necrosis factor production and the mortality caused by LPS and that LZM may be useful for the treatment of endotoxin shock.

Determination of a new immunosuppressant, mycophenolate mofetil, and its active metabolite, mycophenolic acid, in rat and human body fluids by high-performance liquid chromatography

Mycophenolate mofetil, a new immunosuppressant, is a morpholinoethyl ester of mycophenolic acid. A new selective, sensitive and simple high-performance liquid chromatographic method was developed for the determination of mycophenolic acid and mycophenolate mofetil in biological samples. The preparation of samples was based on liquid-liquid extraction. The compounds were separated on a CN column using acetonitrile-0.01 M phosphate buffer (1:4, v/v) as the mobile phase. UV detection was used at wavelengths 215 and 304 nm. The detection limit was 5 ng per injection volume. This method enabled pharmacokinetic and pharmacodynamic studies in humans and rats.

[Strongyloidiasis associated with multiple myeloma in Ehime prefecture]

A 76-year-old male with multiple myeloma, who was born and had lived in Ehime Prefecture was admitted to our hospital because of high fever. The chest X-p film showed right middle lobal pneumonia. Eosinophilia was detected and a stool smear examination revealed rhabditis form larvae of the nematode. The filaria form larvae of Strongyloides stercoralis were detected by stool culture. Antibiotics and pyruvinium pamoate were administered to bacterial pneumonia and hyperinfection of the strongyloides, respectively. Consequently, pneumonia and strongyloidiasis were promptly improved. It was considered that he was infected with strongyloides in south-east Asia during World-War II and a little autoinfection of this nematode had continued about 50 years. In addition, it was suggested that hyperinfection of strongyloides resulted from the immunosuppressive state induced by the chemotherapy for multiple myeloma.

Ubiquitin and ubiquitin-protein conjugates in PC12h cells: changes during neuronal differentiation

Ubiquitin and ubiquitin-protein conjugates in PC12h cells were detected with in vitro [125I]ubiquitination, and quantified by immunoblotting. These levels were altered by nerve growth factor (NGF), which promotes neuronal differentiation. (i) Levels of high molecular weight (HMW) ubiquitin-protein conjugates ranging from 40 to 1,000 kDa were increased by 2 days of NGF treatment, and remained high up to 10 days of NGF treatment. (ii) Ubiquitin and a 23-kDa conjugate tended to be decreased from days 2 to 10 of NGF treatment. 10-Day culture with 10 nM staurosporine, n protein kinase inhibitor, that blocks NGF-induced neurite outgrowth suppressed the NGF-induced increases in levels of HMW conjugates. Cyclic AMP and forskolin, both of which promote neurite outgrowth, mimicked the NGF-induced changes in ubiquitin and HMW conjugates, but phorbol ester and epidermal growth factor had little effect. These findings suggest that changes in ubiquitin-protein conjugates are closely coupled with neuronal differentiation.

Successful treatment of transfusion-associated graft-versus-host disease

We present an immunocompetent patient with transfusion-associated graft-versus-host disease (GVHD), in which chimaerism of peripheral blood lymphocytes was demonstrated by analysis of a highly polymorphic genome. The patient was treated successfully with anti-CD3 monoclonal antibody, OKT3 and cyclosporin A. Although it is undoubtedly important to prevent transfusion-associated GVHD by irradiation of cellular blood components, intensive therapy with OKT3 and cyclosporin A in the early phase of onset may be effective for treatment of this potentially fatal condition. The mechanism of the effectiveness of this treatment for transfusion-associated GVHD is discussed.

Antiphospholipid antibodies. A prognostic factor in sarcoidosis?

Serum antibodies against five types of phospholipids, antiphospholipid antibodies (aPL), were determined by an enzyme-linked immunosorbent assay in 55 patients with sarcoidosis. Either IgG or IgM aPL were detected in 21 patients (38 percent). This positive rate was significantly higher than that (7 percent) of healthy control subjects (p < 0.001). In terms of immunoglobulin classes, 5 cases had IgG aPL only, 11 cases had IgM aPL only, and 5 cases had both classes of aPL. No correlation was observed between the occurrence of aPL and disease activity of sarcoidosis. A significant correlation was noted between the occurrence of aPL and many extrathoracic organ lesions or the persistence of abnormal chest x-ray film findings for periods of 2 and 5 years. Taken together, the presence of aPL in sarcoidosis is a useful index to judge the prolongation of the disease.

A novel heparin-binding protein, HBp15, is identified as mammalian ribosomal protein L22

A 15kDa-protein (HBp15) was purified from mouse submandibular gland and bovine brain by virtue of its heparin-binding property. The amino acid sequences of mouse and bovine HBp15 showed a high degree of homology to a sea urchin protein encoded by gene called "development specific protein 217." Using reverse transcription-polymerase chain reaction methods, cDNA clones for HBp15 were isolated from submandibular gland mRNA of mouse, human and pig, and sequenced. Database search of HBp15 showed that HBp15 also resembles yeast ribosomal protein YL31 in addition to the 217 protein. Using specific antibodies against HBp15, HBp15 was identified as mammalian ribosomal protein L22, for which no sequence information is available.

Purification and characterization of hepatocyte growth factor (HGF)-converting enzyme: activation of pro-HGF

Hepatocyte growth factor (HGF) is a heterodimer protein, derived from an inactive single-chain precursor (pro-HGF) by the proteolytic cleavage at Arg-Val site. Using a fluorogenic substrate Ac-Lys-Thr-Lys-Gln-Leu-Arg-MCA corresponding to the sequence around the cleavage site of pro-HGF, HGF-converting enzyme was purified from fetal bovine serum. The enzyme is a heterodimer molecule with an apparent molecular weight of about 90-kDa and is composed of a 65-kDa heavy-chain and a 32-kDa light-chain. The enzyme belongs to the serine-protease family and has an optimal pH around 8. The enzyme preferentially cleaved MCA-substrates containing the processing site of pro-HGF. The purified enzyme converted pro-HGF to a two-chain mature form of HGF. The enzyme-treated pro-HGF had mitogenic activity on primary cultured hepatocytes. Thus, the enzyme is likely to be involved in pro-HGF activation in vivo. The enzyme activity in rat serum was 9-fold higher than that in the plasma. This, together with the heterodimeric structure of the enzyme, suggests that the HGF-converting enzyme is activated by another protease in response to a trigger such as blood coagulation or tissue injury.

[Intermittent intraarterial infusion chemotherapy using a subcutaneously implanted reservoir in patients with hepatoma]

Hepatocellular carcinomas that should not be treated with transarterial embolization (TAE) were treated with intermittent intraarterial infusion chemotherapy using a subcutaneously implanted reservoir. Among 37 patients, in whom objective evaluation of the initial response was possible, 3 cases of CR, 12 of PR, 10 of NC and 12 of PD were obtained. The response rate was 40.5%. Culminate 1 year survival rates were 80.0% for responders (CR + PR), 4.5% for non-responders (NC + PD) and 35.1% as an average for all patients. The survival in responder patients was better than in non-responders (p < 0.001). To determine the role of this therapy we divided the cases into two groups by anamnesis of TAE and investigated the initial response and prognosis based on the grade of portal vein invasion in each group. In one group of 18 patients, who had not been treated with TAE, there were no relationships between the grade of portal vein invasion and the initial response and between the grade of portal vein invasion and the prognosis. In this group the initial response was better in patients whose one shot infusion chemotherapy immediately before intermittent intraarterial infusion chemotherapy had been effective than in the others. In the other group of 19 patients, who had been treated with TAE, the initial response and prognosis were better in patients with lower grades of portal vein invasion (Vp0-2) than in those with the highest grade (Vp3).

[Levels of soluble CD4 and soluble CD8 in patients with sarcoidosis]

Levels of soluble CD4 (sCD4) and soluble CD8 (sCD8) in serum and bronchoalveolar lavage fluid (BALF) were determined in 36 patients with sarcoidosis and 20 healthy controls by an ELISA method. In addition, the possible sources of sCD4 and sCD8 were examined in detail. The sCD4 levels in serum did not differ significantly between sarcoidosis patients and controls. The sCD8 levels in the sera of sarcoidosis patients with a high serum angiotensin-converting enzyme (ACE) level were significantly higher than those of patients with a normal serum ACE level (413 +/- 148 U/ml vs. 297 +/- 76 U/ml, p < 0.01). The high ACE group also had significantly increased serum sCD8 levels as compared to controls (323 +/- 111 U/ml, p < 0.05). In the sarcoidosis patients, the mean serum sCD8 level was 308 +/- 46 U/ml in stage 0, 339 +/- 107 U/ml in stage I, 557 +/- 141 U/ml in stage II, and 474 +/- 211 U/ml in stage III. The stage II group had a significantly higher sCD8 level than either the stage 0 or I groups (p < 0.05). In the sarcoidosis patients, the sCD8 level correlated significantly with the level of either ACE or soluble Interleukin-2 receptor in serum (p < 0.05). The sCD4 level in BALF was significantly higher in sarcoidosis patients than in controls (4.10 +/- 1.90 U/ml vs. 2.39 +/- 0.12 U/ml, p < 0.01), while the sCD8 level in BALF tended to be higher in sarcoidosis patients than in controls (4.31 +/- 4.39 U/ml vs. 2.02 +/- 1.52 U/ml).(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of intralesional injection of cisplatin on squamous cell carcinoma and normal tissue of mice

Iodized oil as a drug carrier system for intralesional injection of cisplatin was assessed using human squamous cell carcinoma and normal tissues (kidney and small intestine) of BALB/c nu/nu mice. The results were compared to intralesional and intraperitoneal injections of cisplatin dissolved in distilled water. The following were assessed: change in tumor volume, increase or decrease in body weight of mice, and bromodeoxyuridine uptake of tumor, kidney and small intestine. Tissue platinum concentrations were also measured. Results showed that iodized oil may prove to be beneficial as a drug carrier system of cisplatin.

[Clinical study of anti-phospholipid antibody in patients with sarcoidosis]

Serum antibodies against five types of phospholipids were measured by enzyme-linked immunosorbent assay (ELISA) in 55 patients with sarcoidosis. In 21 cases (38%), either IgG antibodies or IgM antibodies were detected. These antibodies were thought to mainly be infective type. This positive rate was significantly higher than that (7%) of the control group (70 cases) (p < 0.01). As to the immunoglobulin classes, 5 cases had IgG antibodies only, 11 cases had IgM antibodies only, and 5 cases had both IgG and IgM antibodies. No correlation was observed between the occurrence of anti-phospholipid antibodies (APL-Ab) and disease activity of sarcoidosis. Significant correlations were found between the occurrence of APL-Ab and skin lesions, many extrathoracic organ lesions and the persistence of abnormal chest X-ray findings for over 2 years and 5 years. From these data, it is suggested that the presence of APL-Ab is associated with prolonged disease activity of sarcoidosis.

[Malignant lymphoma with various neuropsychological symptoms]

A case of malignant lymphoma presented with various neuropsychological symptoms which made it difficult to achieve the diagnosis and therapy. A 9-year-old boy was referred to our hospital with complaints of psychological symptoms, impairment of consciousness and generalized convulsive seizures. A lumbar puncture revealed infiltration of numerous blasts which were positive for immature B cell markers. CT scan showed a mass in the right ethmoidal sinus, but no space occupying lesion in the brain. The tumor cells in the right ethmoidal sinus had the same phenotypes as those in the CSF. Thus a diagnosis of non-Hodgkin's lymphoma, developing in the right ethmoidal sinus and infiltrating into the central nervous system, was established. The blast cells in the liquor and the tumor of the right ethmoidal sinus disappeared after induction of systemic chemotherapy, irradiation and intrathecal chemotherapy. However, intracranial bleeding occurred during the chemotherapy. He died of respiratory failure 10 months after the start of treatment.