Analysis of 70 KD heat shock protein (HSP70) expression in the lesional skin of lupus erythematosus (LE) and LE related diseases

Biopsied specimens from skin lesions of SLE were studied for expression of 70 KD heat shock protein (HSP70). The pattern of HSP70 expression in SLE was diffuse in whole epidermis, hair follicles, and sweat gland cells and rather more intense than that in other control groups or normal skin. No significant differences in HSP70 expression were observed between sun-exposed and protected areas of SLE skin lesions. Unlike SLE, reduced or no expression of HSP70 was observed in skin lesions of DLE. In tissue culture, UVB radiation in vitro induced relatively intense expression of HSP70 in the nuclear area of keratinocytes. A few gamma delta T cell receptor positive cells which might respond to HSP70 expressing cells were detected in the basal layer of skin lesions of diseases. These studies suggest that aberrant expression of HSP70 in skin lesions of SLE might contribute to both skin lesions and antibody formation in SLE.

A new variant of punctate acrokeratoderma associated with a pigmentary disorder

We report a Japanese patient with skin-coloured keratotic papules on the hands and feet, and pronounced hyperkeratosis of the palms and soles. There was no evidence of fragmentation of dermal elastic tissue on histology. Freckle-like pigmentation was also present on the dorsa of the hands and feet, and this appeared to be closely related to the keratotic disorder. The mode of inheritance was autosomal dominant. We consider our case to be a new variant of familial punctate acrokeratoderma, associated with a pigmentary disorder.

Seasonal change in maximal expiratory flow-volume pattern in patients with Japanese cedar pollenosis

Fifteen patients with Japanese cedar pollenosis were examined for lower airway function. Flow-volume patterns obtained from flow-volume and volume-time curves during the pollen season (March) and outside of the pollen season (June) were evaluated. In a previous report we classified maximal expiratory flow-volume (MEFV) curves in five patterns from A to E. In the present study, the patterns did not vary between the two periods except in one patient. Eleven patients out of 15 showed type E patterns, in which the flow-volume curve was concave along its entire course. In most of the patients with severe or moderate symptoms of allergic rhinitis only during the pollen season, the curve shifted to the right, but the parameters of the curves did not increase significantly outside of season. These findings suggest that patients with Japanese cedar pollenosis suffer from continuous latent peripheral airway obstruction. Extremely slight changes in the flow rate were detected by comparing the curves obtained during the two periods.

A comparison of induced heat-shock protein in neurons destined to survive and those destined to die after transient ischemia in rats

We examined the induction of heat-shock protein (HSP) in CA-1 pyramidal neurons compared with that in CA-3 pyramidal neurons, in rat brain following 20 min of ischemia. The time course of the changes of localization of HSP was investigated using immunohistochemical and Western blot analyses. The induction of HSP in the CA-1 subfield was the same as that in the surviving hippocampal CA-3 subfield.

Rheumatic manifestation of human leukemia virus infection

Rheumatic disorders associated with retroviruses are described in this article. A recent study of human T-cell leukemia virus type-I (HTLV-I) revealed that it appeared to be associated with the pathogenesis of several immune disorders such as myelopathy, broncho-pneumopathy, Sjogren's syndrome, and arthropathy. HTLV-I-associated arthropathy (HAAP) shows remarkable synovial proliferation with nuclear convoluted T-cell infiltration in both synovium and synovial fluid. Synovial cells obtained from HAAP patient-integrated HTLV-I proviral DNA and also expressed mRNA for HTLV-1 tax gene; moreover, HTLV-1 integrated synovial cell clones expressed a high level of mRNA for several oncogene and growth factors compared with HTLV-I non-integrated clones. These findings suggest that HTLV-I is the first exogenous retrovirus that contributes to synovial proliferation with immune disorders in humans.

Clinical staging and gadolinium-DTPA enhanced images of the wrist in rheumatoid arthritis

The usefulness of gadolinium (Gd)-DTPA enhanced magnetic resonance imaging (MRI) of the wrist joint for predicting articular destruction was investigated in 49 patients with rheumatoid arthritis (RA). On T1 weighted images with Gd-DTPA enhancement, the synovium showed a localized or diffuse pattern of enhancement. Many patients classed as stage II or higher by plain radiography had diffuse enhancement on MRI, while all except one stage I patient had relatively confined localized enhancement. Our study showed that MRI of the carpus could detect soft tissue changes in patients with RA earlier than anything revealed by radiography, and suggested that contrast MRI may be useful for predicting articular destruction.

B cell epitope on the U1 snRNP-C autoantigen contains a sequence similar to that of the herpes simplex virus protein

The mechanism of autoantibody production in autoimmune diseases is not well understood. In the present study we performed the B cell epitope mapping of the U1 small nuclear ribonucleoprotein (snRNP)-C, one of the target molecules of anti-nRNP autoantibody to investigate how B cells respond to the autoantigen. After cloning and expression of a full length complementary DNA (cDNA) encoding the U1-C protein, several truncated mutants of the cDNA were constructed and expressed in E. coli. Although a few epitopes were distributed on the whole molecule, all anti-C protein antibody-positive patients' sera tested recognized the region between amino acid residues 102 and 125 of the coding sequence. This universal epitope region contains an amino acid sequence similar to that of the herpes simplex virus type 1 ICP4 protein. The peptides representing each molecule were cross-reactive to each other. In addition this region cross-reacted to the B/B' protein. These observations suggest that molecular mimicry might be involved in the initiation of autoantibody production, followed by cross-reactive events between the autoantigens and by antigen-driven mechanisms to generate more complicated autoantibody patterns against the U1 snRNP complexes.

[Studies on screening for hard-of-hearing children by questionnaire. 2. Comparison of response rates to individual questions in 1-year-6-month-old children with normal hearing and hearing loss using a health screening questionnaire]

We report the results of studies on responses to questions on hearing impairment, comparing 165 school children whose hearing was diagnosed as normal at the time of admission to primary school and 37 children with hearing loss attending facilities for children with this disability. These children had been covered by similar surveys as part of the health screening for 1-year-6-month-old infants conducted by municipal authorities. Significant differences between the two groups were noted in the response rates to all questions on hearing. Similar differences were noted in the responses to questions on family history of hearing impairment. There were no significant differences in the incidences of asphyxia and jaundice at birth. The most striking differences were noted in the response rates to questions 6, 7, 8, 10, 11, 16, and 18. Most useful and universally valid in this survey were questions 8, 10 and 18 in addition to the question on whether or not parents suspected infantile hearing loss.

Giant mucocele of oral cavity as a mucocutaneous manifestation of Sjögren syndrome

Two cases of Sjögren syndrome who developed a giant mucocele on the floor of the oral cavity are reported. Histological analysis revealed the dense infiltration of lymph-plasmacytic infiltration around the dilated salivary duct. Similar findings were observed in the biopsied specimens of the labial salivary gland which were consistent with the grade 4 score proposed by Chisholm and Mason's criteria. Mucocele is a common mucocutaneous disease of unknown etiology except for traumatic origin and Sjögren syndrome might be one of the important underlying disease which causes giant mucocele, especially in elderly female patients.

Low temperature dependent IgG3 subclass antibody with low avidity to C100-3 antigen derived from hepatitis C virus in voluntary blood donors

The presence of an antibody which reacts strongly at lower temperatures to C100-3 antigen derived from the hepatitis C virus (HCV) was demonstrated in blood donors' sera. These sera reacted with the antigen most strongly at 4 C and most weakly at 37 C and are termed 'cold antibody group'. The cold antibody group reaction was specifically inhibited with soluble C100-3 antigen. Cold antibody bound to C100-3 antigen at 4 C was dissociated at 37 C and was isolated in this manner. Low temperature-dependent anti C100-3 antibody was shown to be predominantly IgG3 subclass by ELISA using anti-human IgG subclass antibody. This IgG3 antibody was dissociated from antigen with 6M urea, demonstrating its low avidity. HCV-RNA was demonstrated in two of five samples. Therefore, to achieve more effective prevention of post-transfusion hepatitis C, we propose the incorporation of programs to detect low temperature-dependent low-avidity antibody against HCV-related antigen.

Eosinophil cationic protein in the nasal secretions of patients with mite allergic rhinitis

In 25 patients with mite nasal allergy and 13 healthy control subjects, levels of eosinophil cationic protein (ECP) and histamine in nasal secretions were examined before and after challenge with mite extract. The ECP level was found to be significantly higher in the washings taken 30 minutes after challenge compared with the washings taken before challenge (P < .05). ECP levels measured both before and after mite extract challenge were found to be significantly higher in the patients than in the controls (P < .01). These facts suggest that the ECP affects the nasal mucosa by causing injury to ciliated cells and by acceleration of the processes of modification and inhibition of the allergic reaction.

Iatrogenic benign lymphoplasia induced by allergic contact dermatitis from squaric acid dibutylester: immunohistologic study of cellular infiltrates

We report of a 62-year-old male patient with a dull red itchy nodule on the induction area of allergic contact dermatitis to squaric acid dibutylester, which had been used for the therapy of alopecia universalis. The excised biopsy specimen showed dense infiltration of lymphoid cells in the dermis and subcutaneous tissue, associated with the formation of lymphoid follicles. Immunohistologic analysis of the infiltrates indicated mixed proliferation of T- and B-cells. A biopsy specimen from the challenge area showed spongiosis in the epidermis and lymphoid cell infiltration in the upper dermis, while the infiltrates consisted mainly of T-cells. The following points are discussed: (i) the lesion had an iatrogenic origin and the causative agent was quite evident; (ii) the route of allergen application was only through the epidermis and not directly in the dermis; (iii) lymphoid cell infiltrates of the induction and challenge areas were different.

Uptake of acetylated low density lipoprotein (ac-LDL) by synovial cells

Acetylated low density lipoprotein (ac-LDL) is known to be incorporated into monocyte/macrophages. We examined the uptake of fluorescence-labeled ac-LDL as well as the surface expression of CD14 using flow cytometry, in order to identify macrophage-like type A synoviocytes in the synovium of patients with rheumatoid arthritis (RA) (n = 15) and osteoarthritis (OA) (n = 5). The mean (+/- SD) percentage of ac-LDL uptake cells in RA synoviocytes (38.3 +/- 19.9%) was relatively higher than that in OA synoviocytes (16.6 +/- 8.7%) (p < 0.05). Also the proportion of ac-LDL incorporating cells paralleled, but was higher than, that of CD14 positive cells (r = 0.91, p < 0.001). This method is helpful in determining macrophage-like type A synoviocytes, and the presence of CD14-negative macrophage-like synoviocytes has been revealed.

Induction and characterization of mast cell colonies by culture supernatant of retinoic acid-treated mouse keratinocytes

The retinoic acid-stimulated mouse-transformed epidermal cell line Pam 212 generated soluble mediators (RA-Pam sup) which showed mast cell-proliferating activity and induced mast cell-like colonies from bone marrow cells. Both mucosal-type and connective tissue-type mast cells were demonstrated on histochemical analysis. The 3T3 fibroblast cell line or human trichilemmomal cell line (TL1) also generated similar molecules on retinoic acid stimulation. Anti-stem cell factor antibody presented a rather more potent inhibitory activity on RA-Pam sup-dependent mast cell colony formation than did anti-IL3 and -IL4 antibodies. RA-Pam sup only induced mast cell colonies in semisolid culture and failed to promote mast cell growth in a suspension culture. In addition, mast cell colonies showed close contact with fibroblast-like cells on the methylcellulose plate, but this finding was not observed in culture without RA-Pam sup.

Down-regulation of murine contact sensitivity by hapten-amino acid derivatives

The low responsiveness of contact sensitivity (CS) in sensitized and challenged mice was induced by using hapten-amino acid derivatives. Subcutaneous injection of trinitrophenyl (TNP)-lysine or oxazolone-glycine inhibited ear swelling responses in mice that received rechallenge. The inhibitory effect was long-lasting and antigen-specific. TNP-lysine blocked the transfer of CS in vivo and the binding of immune lymph node cells to antigen in vitro. Thus, the suppression was mediated by inhibition of effector cells, but not associated with the generation of efferent limb-acting suppressor cells. The tool reported herein seems to be quite useful for controlling ongoing murine CS to simple chemicals.

The role of metal allergy and local hyperhidrosis in the pathogenesis of pompholyx

Pompholyx (Dyshidrosis) is a disease of unknown etiology presenting as symmetrical, vesicular hand and foot dermatitis. To clarify the pathogenetic role of sweat and metal allergy, twenty five patients with pompholyx were examined with respect to their perspiration volume using equipment that continuously recorded the local perspiration volume. Patients were also examined for metal allergy by patch testing and oral challenge tests. The perspiration volumes were measured using recently developed equipment for continuous recording of local perspiration volume (Kenz-Perspiro oss-100). The perspiration volume of pompholyx patients was found to be 2.5 times higher than that of age-matched normal controls. Twenty percent of the patients showed sensitivity to chromate, 16% to cobalt, and 28% to nickel on patch testing. Six patients with positive results were challenged orally in a controlled trial with 2.5 mg nickel, 1 mg cobalt, or 2.5 mg chromium. Four of them (67%) showed vesicular reactions on their hands with challenge testing. These results indicated a sensitivity to metal compounds which, in combination with local hyperhidrosis, may contribute to the development of vesicular lesions in pompholyx.

Xeroderma pigmentosum: recent clinical and photobiological aspects

In Japan, more than 400 patients with xeroderma pigmentosum (XP) have been registered. The major groups are XP-A and variant, while clinically mild types of XP with intermediate levels of unscheduled DNA synthesis (UDS) have recently been increasing. The classical type of XP-A and some of the XP-D patients exhibit neurologic abnormalities. XP individuals display a marked increase in the frequency of skin malignancy. Development of skin malignancies appears to be related to the level of DNA repair capacity; the lower the capacity, the earlier and more frequently the skin tumors develop. Furthermore, the incidence of internal malignancy in XP patients is at least ten times higher than that for the Japanese general population over the age of 40 years. Cultured fibroblasts from XP patients exhibit higher sensitivity not only to UVC but also to UVB. The cellular sensitivity to UVB may correlate to photosensitivity in vivo from a study on a group E patient who showed age-related changes in photosensitivity and cellular sensitivity to UVB. We have also reviewed current status of molecular genetics in XP.

Accumulation of multiple T cell clonotypes in the synovial lesions of patients with rheumatoid arthritis revealed by a novel clonality analysis

T cell activation in the characteristic synovial lesions of rheumatoid arthritis may play a major role in the pathogenesis of this autoimmune disease. Analysis of T cell clonal diversity in these sites remains equivocal. Using the PCR and subsequent single-strand conformation polymorphism analysis it is possible to assess the degree of junctional diversity in the TCR with minimal selection bias. Concentrating on the beta-chain of the TCR, a paucity of clonotypic T cell expansion is demonstrated in the peripheral blood of healthy individuals. After polyclonal stimulation in vitro (with concanavalin A or phytohemagglutinin) this pattern does not change. In contrast, some T cell clonotypes appear following in vitro stimulation with purified protein derivative. Analysis of the peripheral blood, synovial fluid, and synovial tissue of patients with rheumatoid arthritis indicated many dominant T cell clonotypes. These data argue for a clonally diverse T cell response in the affected tissues of rheumatoid arthritic subjects.

Detection of myeloid precursors (granulocyte/macrophage colony forming units) in the bone marrow adjacent to rheumatoid arthritis joints

Various cytokines were recently found to be involved in the pathogenesis of rheumatoid arthritis (RA) and particularly, cytokines with hematopoietic activity have been detected in synovial tissues. We counted the number of myeloid precursors in terms of granulocyte/macrophage colony forming units (CFU-GM) and the number of stromal cell progenitors in terms of fibroblast colony forming units (CFU-F) in the tibial bone marrow adjacent to the joints affected by RA (n = 21), osteoarthritis (OA) (n = 10), and trauma (n = 2) using the colony formation unit assay. We also quantitated the amounts of interleukin 1 beta (IL-1 beta), IL-6, and granulocyte/macrophage colony stimulating factor (GM-CSF) in the culture supernatant of synovial tissue explants of these patients by enzyme linked immunosorbent assay (ELISA). The mean number (+/- SEM) of CFU-GM in patients with RA (7.4 +/- 4.9) was greater than that in patients with OA (0.5 +/- 0.2), while CFU-GM was not detected in trauma patients. The number of CFU-GM in the tibial bone marrow of patients with RA correlated well with the amount of IL-1 beta (r = 0.64, p < 0.01), but not with GM-CSF or with IL-6 from synovial tissues. These findings suggest that active bone marrow is present adjacent to the affected joints in patients with RA and that hematopoietic activity is influenced by IL-1 beta produced in nearby synovial tissues.

Resistance of hippocampal CA-1 noradrenergic fibers to five minutes of transient cerebral ischemia in the gerbil

We examined changes in the tyrosine hydroxylase (TH)-immunoreactive fibers following 5 min of cerebral ischemia in gerbils using an immunohistochemical method 1, 3 and 30 days after ischemia. Almost all CA-1 pyramidal neurons were lost 3 days after ischemia, whereas noradrenergic fibers were maintained 30 days after ischemia. The present study demonstrated that TH-immunoreactive fibers and cells were resistant to transient ischemia, and that there was no sprouting or hyperactivity in noradrenergic systems after ischemia.

Severe progressive erosive arthritis in multicentric reticulohistiocytosis: possible involvement of cytokines in synovial proliferation

A case of multicentric reticulohistiocytosis complicated by severe progressive erosive arthritis in a 40-year-old man is described. The diagnosis was confirmed by biopsies of the cutaneous nodule and the synovial tissue of the right knee joint. Destructive changes in the multiple joints rapidly progressed and resulted in severe progressive erosive arthritis. Immunohistochemical staining revealed that the histiocytes reacted positively to interleukin 1 beta and platelet derived growth factor B, leading to the speculation that these cytokines may play a role in the synovial proliferation seen in patients with multicentric reticulohistiocytosis.