Role of macrophages in pulmonary late-phase reaction in guinea pigs

To examine the role of macrophages in pulmonary late-phase reaction (LPR), macrophages were reduced in sensitized guinea pigs by an intravenous injection of liposome-encapsulated dichloromethylene diphosphonate (Cl2MDP). Macrophage reduction was evaluated by bronchoalveolar lavage (BAL) fluid analysis. In Cl2MDP liposome-treated animals, the number of macrophages in BAL fluid significantly decreased by 56% compared with PBS liposome-treated animals (1.6 +/- 0.1 vs. 3.6 +/- 0.4 x 10(6) cells, p < 0.01). The number of neutrophils, eosinophils, or lymphocytes in BAL fluid showed no significant changes in these two groups. Both PBS and Cl2MDP liposome-treated sensitized guinea pigs were challenged with an inhalation of antigen, and respiratory resistance (Rrs) was measured. PBS liposome-treated animals (control) exhibited both immediate (IPR) and late (LPR) increases in Rrs. The maximal increases in Rrs at IPR and LPR were 217 +/- 19 and 187 +/- 20% of baseline values, respectively (n = 9). On the other hand, Cl2MDP liposome-treated animals showed an immediate increase in Rrs (IPR); however, the late increase in Rrs (LPR) was significantly suppressed (p < 0.05). The maximal increases in Rrs at IPR and LPR were 200 +/- 13 and 134 +/- 11% of baseline values, respectively (n = 8). In Cl2MDP liposome-treated animals, the numbers of macrophages and neutrophils in BAL fluid 4 hr after antigen challenge decreased by 45% and 54%, respectively, compared with PBS liposome-treated animals (p < 0.05). In Cl2MDP liposome-treated animals, neutrophil chemotactic activity in BAL fluid 4 hr after antigen challenge decreased by 59% compared with PBS liposome-treated animals (p < 0.05). These results suggest that macrophages play an important role in the development of pulmonary LPR through the induction of neutrophil accumulation in the airways.

[Significance of 123I-metaiodobenzylguanidine SPECT for detecting left ventricular involvement in patients with arrhythmogenic right ventricular dysplasia]

The right ventricle being primarily involved in ARVD, recent reports indicate the presence of histological and functional abnormalities in the left ventricle for some patients with ARVD. The aim of this study was to evaluate the significance of myocardial sympathetic dysfunction as an early sign of left ventricular (LV) involvement by 123I-MIBG (MIBG) SPECT and to compare the findings with those of 201TlCl (Tl) SPECT, radionuclide left ventriculography, ultrafast computed tomography (UFCT), magnetic resonance imaging (MRI) and echo-cardiography in 10 patients (pts) with ARVD. MIBG defects in LV regions were detected in 9 pts. Seven of the 9 pts showed MIBG defects in LV regions adjacent to RV. The subjects were divided into 2 groups based on left ventriculography, 5 with normal LVEF (> 55%) and 5 with reduced LVEF. In the normal LVEF group, 4 pts showed MIBG defects and 2 pts showed TI defects, and MIBG defects were larger than TI defects (ES: 14 +/- 6 vs. 5 +/- 7, p <0.05). In reduced LVEF group, all of 5 pts showed MIBG and TI defects, and MIBG defects were larger than TI defects (ES: 42 +/- 12 vs. 25 +/- 3, p <0.05). In comparison with normal LVEF group, reduced LVEF group showed larger and more severe MIBG defects (ES: 42 +/- 12 vs. 14 +/- 6, p <0.01, SS: 44 +/- 31 vs. 8 +/- 7, p <0.05). UFCT and MRI showed abnormal findings indicating LV fatty infiltration in only 3 of reduced LVEF group. Thus, MIBG showed abnormal distributions in the left ventricle with the highest frequency in all these modalities. These results suggest that MIBG SPECT provides a sensitive marker for detecting LV involvement in ARVD. Also, the extent of MIBG distribution abnormalities is helpful in assessing the severity of left ventricular involvement in patients with ARVD.

Rapid growth of hepatocellular carcinoma after or during interferon treatment of chronic hepatitis C: report of three cases

We report herein the cases of three patients in whom marked rapid growth of hepatocellular carcinoma (HCC) became evident after or during interferon (IFN) treatment for chronic hepatitis C. The HCC tumors were 10, 4.7, and 3.1 cm in size, and were found 7 months, 10 weeks, and 10 weeks after the initiation of IFN, respectively, in cases 1, 2, and 3. The clinical courses of these three patients suggest that the progression of HCC was more rapid during the IFN treatment period. Thus, we propose that abdominal ultrasonic (US) examination should be performed monthly in patients with chronic hepatitis who undergo IFN treatment.

Endothelial cell differentiation into capillary structures by copolymer surfaces with phenylboronic acid groups

A ternary copolymer composed of m-acrylamidophenylboronic acid, N,N-dimethylaminopropylmethacrylamide and N-isopropylacrylamide was synthesized. Long-term culture of bovine aortic endothelial cells on this copolymer substrate demonstrated adhesion and proliferation of the cells. After 26 days in culture, endothelial cells spontaneously developed into capillary networks. The interactions between phenylboronic acid groups in copolymer and glycoconjugates on endothelial cell plasma membranes are proposed to regulate the induction of tissue formation, since phenylboronic acid groups are known to specifically form reversible complexes with cis-diol compounds such as glucose. This copolymer is a novel material capable of mediating specific signals analogous to extracellular matrix to promote proliferation of endothelial cells, inducing capillary structures and prompt angiogenesis.

Chronologic analysis of eosinophil granule protein deposition and cell adhesion molecule expression in mite allergen-induced dermatitis in atopic subjects

To investigate the process of eosinophil recruitment in atopic dermatitis (AD), patch testing with crude dust-mite allergens was performed on normal-appearing skin of 9 adult AD patients with high levels of mite-specific IgE antibodies. Positive reactions were observed in 6 AD subjects, whereas 0 of 7 control subjects showed positive reactions to mite allergens. Positive reaction sites were biopsied chronologically and studied histologically and immunohistochemically. Eosinophils were seen in postcapillary venules in the dermis at 2 h, followed by infiltration of eosinophils at 6 h which peaked at 24 and 48 h. In the epidermis, eosinophilic spongiosis was seen at 48 h. Positive reactions against eosinophil granule proteins were observed in connective tissues as well as on eosinophils. Almost all infiltrating eosinophils were positive for BMK-13 (an antibody against major basic protein); half of them were positive for EG2 (an antibody against eosinophil cationic protein). With regard to adhesion molecules, expression of E-selectin and intercellular adhesion molecule-1 endothelial cells was up-regulated as infiltrating eosinophils increased in number. These findings suggest that eosinophil transmigration from endothelial cells and eosinophil degranulation play important roles in initiating early AD lesions induced by transepidermal mite allergen permeation.

Fat-soluble vitamins in patients with chronic pancreatitis (pancreatic insufficiency)

The fat-soluble vitamin contents in the blood (vitamins A, D, E, and K) were determined in 12 patients with chronic pancreatitis (exocrine pancreatic insufficiency) and in 20 healthy adults by the HPLC and CPBA methods. In addition, 9 g (3 g x 3 times) of high potency pancreatin was given to 11 patients with chronic pancreatitis (CP) for approximately 1 month and changes in the blood fat-soluble vitamin levels were evaluated before and after the treatment. The major component of vitamin E was alpha-tocopherol. The mean alpha-tocopherol level in normal individuals was 0.97 mg/dl, while it was significantly reduced in CP patients (p < 0.01). The vitamin A, D, and K levels had also been reduced in patients with CP, but the differences were not significant (although some patients in this group exhibited significant reductions from the levels of normal individuals). Only the blood vitamin E level showed a significant correlation with the fecal fat excretion or the fat absorption rate. None of the patients with CP exhibited an overt fat-soluble vitamin deficiency (i.e., the deficiency of fat-soluble vitamins was at a subclinical level). These results indicated that CP patients suffer from a latent fat-soluble vitamin deficiency and that the vitamin E level is closely related to a dysfunction of fat digestion. It was suggested that the dietary intake of each fat-soluble vitamin should be evaluated further.

Intracranial calcification on gradient-echo phase image: depiction of diamagnetic susceptibility

PURPOSE

To differentiate calcification from hemorrhage on the basis of susceptibility at magnetic resonance imaging.

MATERIALS AND METHODS

Gradient-recalled echo (GRE) phase imaging was performed at 1.5 T in 101 calcified areas (15 in the basal ganglia, 86 out of the basal ganglia) and 39 uncalcified locations (13 choroid plexus and pineal glands, 26 old hemorrhages). Experiments with a small lead particle and a numerical simulation were also performed.

RESULTS

The majority of calcifications outside the basal ganglia (n = 63) revealed a phase shift that represents diamagnetic susceptibility and was similar to the phase shift in the lead particle and to the calculated phase shift for a diamagnetic sphere. All hemorrhages and almost all calcified basal ganglia revealed a phase shift that represents paramagnetic susceptibility. All uncalcified choroid plexus and pineal glands revealed no obvious phase shift. Any location without calcification did not reveal the diamagnetic phase shift.

CONCLUSION

GRE phase imaging differentiated paramagnetic from diamagnetic susceptibility, which was specific for calcification.

Suppression of mitochondrial succinate dehydrogenase, a primary target of beta-amyloid, and its derivative racemized at Ser residue

beta-Amyloid cores contain considerable amounts of D-Ser and D-Asp residues in Alzheimer's disease. We investigated the cytotoxic effects of various synthetic beta-amyloids, including D-Ser-substituted derivatives, on primary cultured neurons and nonneuronal HeLa cells. beta 25-35, its D-Ser26-substituted derivative, and beta 1-40 in 10-100 nM specifically suppressed mitochondrial succinate dehydrogenase activity [MTT [3-(4,5-dimethylthiazol-2-yl)-2,5- diphenyltetrazolium bromide] reduction] in HeLa cells, which are dependent on ATP production mainly from glycolysis, but did not exert detectable cytotoxicity, assessed by dye exclusion test, NADH levels, and uptake of [3H]Leu and [3H]Tdr. The beta-amyloids, on the other hand, did exert neurodegenerative effects on rat hippocampal cultured neurons in which ATP is mostly synthesized by the mitochondrion. The activities of beta 25-35 and [D-Ser26] beta 25-35 are dependent on their having beta-structures and not random forms. Although beta 25-35 was degraded rapidly by proteinase(s) in brain extract or leucine aminopeptidase, [D-Ser26] beta 25-35 is fairly resistant. These results indicate that one of the primary targets of beta-amyloids is suppression of mitochondrial succinate dehydrogenase, and the vulnerability of the brain of beta-amyloids can be explained by its large dependence on mitochondrial energy production. Moreover, racemization of serine residues of beta-amyloids may be involved in neurodegeneration and formation of senile plaques through escaping from the degradation process by brain proteinases.

Chronologic analysis of in situ cytokine expression in mite allergen-induced dermatitis in atopic subjects

Patch testing with crude dust mite extracts, after removal of horny epidermal layers, was performed on normal-appearing skin of nine adult patients with atopic dermatitis who had high mite-specific IgE antibody levels. Positive skin reactions were observed in seven subjects. Skin biopsy specimens were obtained from positive reaction sites at 2, 6, 12, 24, and 48 hours after allergen challenge and subjected to histologic and immunohistochemical studies and extraction of RNA. Perivascular infiltration of small mononuclear cells began at 2 hours, followed by eosinophilic infiltration at 6 hours, which peaked at 24 and 48 hours. Increased expression of IL-4 messenger RNA was detected with reverse-transcription polymerase chain reaction at 12 and 24 hours, whereas immunohistochemical staining with anti-IL-4 antibody showed positive reactions in connective tissue around infiltrating cells after 2 hours. Expression of IL-5 and tumor necrosis factor-alpha mRNA was upregulated 2 hours after an application of allergen. Interferon-gamma mRNA was not detected. These findings suggest the crucial role of TH2-type cytokines in initiating eosinophil infiltration of mite allergen-induced dermatitis in patients with atopic dermatitis.

Treatment of recurrent hypersomnia with methylcobalamin (vitamin B12): a case report

A 32 year old male patient suffered from recurrent hypersomnia for 12 years was successfully treated with vitamin B12. Episodes of hypersomnia lasting a few days occurred repeatedly a few times each year. Furthermore, the frequency of episodes had increased during the last 2 years. During the administration of vitamin B12, the patient had no episodes of hypersomnia for 6 months. In addition, he did not have any episodes during a follow-up observation period of 17 months after cessation of the treatment. Thus, this case suggests that vitamin B12 may be effective for preventing recurrent hypersomnia.

Adult-onset spinocerebellar dysfunction caused by a mutation in the gene for the alpha-tocopherol-transfer protein

BACKGROUND

Patients with isolated vitamin E deficiency have an impaired ability to incorporate alpha-tocopherol into lipoproteins in the liver and usually have symptoms and signs of spinocerebellar dysfunction before adolescence. Accumulated evidence suggests that the alpha-tocopherol-transfer protein, which is presumed to function in the intracellular transport of alpha-tocopherol, is abnormal in these patients.

METHODS

We studied a patient from an isolated Japanese island who began to have ataxia, dysarthria, and sensory disturbances in the sixth decade of life. His serum vitamin E concentration was low (1.2 micrograms per milliliter [2.8 mumol per liter]). Exons of his gene for the alpha-tocopherol-transfer protein were analyzed by DNA sequencing. We also screened an additional 801 inhabitants of the island for the mutation. Both the normal and mutant alpha-to-copherol-transfer proteins were expressed in COS-7 cells and studied by immunoblot analysis and assay for alpha-tocopherol-transfer activity.

RESULTS

The patient was homozygous for a point mutation that replaces histidine (CAT) with glutamine (CAG) at position 101 of the gene for the alpha-tocopherol-transfer protein. When expressed in COS-7 cells, the missense mutation produced a functionally defective alpha-tocopherol-transfer protein with approximately 11 percent of the transfer activity of the wild-type protein. Of the 801 island inhabitants examined, 21 were heterozygous for the His101Gln mutation. In all affected subjects, including the patient, this mutation cosegregated with an intron-sequence polymorphism. The heterozygotes were phenotypically normal and had serum vitamin E concentrations that were on average 25 percent lower than those of normal subjects (mean [+/- SD], 7.5 +/- 2.2 vs. 10.1 +/- 2.8 micrograms per milliliter [17.4 +/- 5.1 vs. 23.4 +/- 6.5 mumol per liter]; P = 0.002).

CONCLUSIONS

alpha-Tocopherol-transfer protein is a determinant of serum vitamin E concentrations. An abnormality in this protein is a cause of spinocerebellar dysfunction.

[Intraepidermal mass of M. leprae in a case of seborrheic keratosis due to Hansen's disease (LLs)]

A 67-year-old patient has had exanthema in the lower right limb since 51 years ago (16 years old at onset), which underwent repeated remission and recurrence. At present, he has bilateral symmetrical widespread infiltrating exanthema and asymmetrical marked neuralhypertrophy, and has been diagnosed typical LLs (His father had the same disease). The exanthema recurred several years ago, and the patient is being treated for Hansen's disease. He had a dark brown flat elevation with a rough surface and the size of a small finger tip in his right abdominal skin for approximately 20 years. A biopsy was performed, and the specimen was fixed in 10% formalin and paraffin sections were prepared for histopathologic examination. A part of the specimen was processed forscanning electron microscopic examination. Seborrheic keratosis was diagnosed by H & E staining. Acid-fast (FITE) staining, immunohistochemical staining (keratin, S-100 protein, anti-PGL antibody and anti-BCG antibody) and scanning electron microscopy revealed the presence of bacteria (M. leprae) in the dermal foam cells, the matrix with a banded structure and the squamous epithelial cells which normally lack phagocytosis function. Compared to the basal cells of normal epidermis, the basal cells located adjacent to the dermis affected with seborrheic keratosis showed increased proliferation and more marked characteristics of a germinative cell. The degree of differentiation of the basal cells appeared regressed, and they probably possessed augmented phagocytic activity. The phagocytosed bacteria were probably carried by the epidermal cell cycle toward the surface layer. However, bacteria could not be found in the stratum corneum, probably due to an association with the lysosome.

[Assessment for intelligence on patients with Pick's disease]

In contrast to Alzheimer's disease, it is unclear whether the MMS (Mini-Mental State) or the RCPM (Raven's Coloured Progressive Matrices) is clinically useful as a mental test battery in patients with Pick's disease, and it has not been fully evaluated whether intelligence of these patients really deteriorate along with the staging of dementia. The present study aimed to make these problems clear. We administered the MMS and the RCPM to 17 cases of Pick's disease, including 7 cases with predominantly frontal lobe atrophy and 10 cases with predominantly temporal lobe atrophy, which were all classified into 3 groups according to the staging of dementia by using the NM scale (New Clinical Scale for Rating of Mental States). We also investigated whether these patients had "Denkfaulheit" (laziness of thinking) and/or "gogi" aphasia (word meaning aphasia), which may affect performances on the mental test batteries. Two cases with predominantly frontal lobe atrophy and 5 cases with predominantly temporal lobe atrophy were assessed by the same examinations several years later. In cases with predominantly frontal lobe atrophy, all the patients presented with "Denkfaulheit". However, the mean RCPM score was normal in the mildly damaged patients, suggesting that their intelligence were relatively preserved. In the moderately and severely damaged groups, their intelligence could not be assessed owing to their severe "Denkfaulheit". In cases with predominantly temporal lobe atrophy, all the patients had "gogi" aphasia and 3 cases of the severely damaged groups presented with "Denkfaulheit".(ABSTRACT TRUNCATED AT 250 WORDS)

Enhanced expression of type I receptors for bone morphogenetic proteins during bone formation

Type I receptors for bone morphogenetic proteins (BMPs), i.e., BMPR-IA and BMPR-IB, are transmembrane serine/threonine kinases, that bind osteogenic protein-1 (OP-1, also termed BMP-7) and BMP-4. Using antibodies specific to BMPR-IA and -IB, we have studied the expression of BMP type I receptors in the bone formation process during embryonic development and fracture healing. In the mouse embryo, both BMPR-IA and -IB were expressed in condensing mesenchymal cells at 13.5 days post coitum (p.c.). At 15.5 days p.c., expression of BMPR-IB, but not of BMPR-IA, was observed in the cells in perichondrium of developing cartilage. At 17.5 and 19.5 days p.c., expression of both receptors was observed in chondrocytes and in osteoblasts. In normal rat adult bone, expression of BMPR-IA, but not of BMPR-IB, was observed in osteoblasts in the periosteum. Three days after the femoral fracture, expression of BMPR-IA and -IB was up-regulated in cells at the proliferating osteogenic layer of the periosteum. On day 7, both receptors were found in fibroblast-like spindle cells and chondrocytes in the endochondral ossification sites, and osteoblasts in the newly formed trabecular bone. Expression of BMPR-IA was higher than that BMPR-IB in osteogenic layer on day 3 and in osteoblasts in the trabecular bone on day 7. On day 14, expression of BMP type I receptors was observed at similar sites, albeit with lower expression levels than were observed on day 7. The present data suggest that expression of BMP type I receptors is up-regulated during bone formation, and that they may play important roles in bone morphogenesis.

[Comparison between anomia with word comprehension difficulty and Gogi aphasia due to lobar atrophy]

We used naming and pointing tests and a proverb completion task to compare two cases of aphasia that exhibited a selective disturbance of word processing. One patient had anomia with word comprehension difficulty due to partial ablation of the left temporal lobe and the other patient had Gogi aphasia due to lobar atrophy with left temporal predominance. We presented 90 pictures of common objects divided into 9 categories in the naming and pointing tests, and used 10 well-known Japanese proverbs as stimuli in the proverb completion task. Performance of the naming and pointing tests was severely impaired in both patients. In the patient with anomia, words the patient could not name or point to varied from session to session and phonemic cue effects were frequently observed. The proverb completion phenomenon was positive. These findings indicate that the patient had an obstruction of the access route to the intact word store or a partial rarefaction of the word store itself. In the patient with Gogi aphasia, the words the patient could not name or point to were consistent from one occasion to another, and no phonemic cue effects or signs of familiarity were observed at all. The proverb completion phenomenon was totally negative. These findings indicate that the patient has lost the word store itself. MR images in the case of anomia revealed a lesion extending from the anterior to the central portion of the inferior part of the left temporal lobe. In the case of Gogi aphasia, the MR images displayed knife-edged focal atrophy in the anterior aspect of both temporal lobes, more prominently on the left.(ABSTRACT TRUNCATED AT 250 WORDS)

[Auditory comprehension in transcortical motor aphasia due to a medial lesions of the left frontal lobe]

We assessed the anatomical findings and auditory comprehension of six patients with transcortical motor aphasia due to medical lesions of the left frontal lobe. All patients were right-handed and were initially mute for several hours after the onset, and they exhibited mild paresis of the right lower extremity. Their spontaneous speech was sparse and not fluent, and sometimes accompanied by echolalia, but their articulation was normal and repetition was excellent. They had difficulty in recalling words. A diagnosis of transcortical motor aphasia was made on the basis of their clinical symptoms. All patients were found to have an infarct in the left medial frontal region by MRI and/or CT. We administered the Western Aphasia Battery and 50 line drawing pointing task in order to evaluate auditory comprehension. Based on the results we concluded that there is no impairment of auditory comprehension of single words when lesions are limited to the superior frontal gyrus, but that lesions extending to the middle frontal gyrus interfere with auditory comprehension of single words. Our observations indicate that the middle frontal gyrus plays an important role in auditory comprehension of single words. All of the patients displayed impaired auditory comprehension of sentences even when their lesions were strictly limited to the medial frontal lobe. This suggests that the medial frontal lobe plays some role in the auditory comprehension of sentences.

A mutation in the beta 3-adrenergic receptor gene is associated with obesity and hyperinsulinemia in Japanese subjects

The Trp 64 Arg mutation in the beta 3-adrenergic receptor (beta 3AR) gene was investigated in 350 Japanese subjects. This mutation was not associated with non-insulin-dependent diabetes mellitus (NIDDM). In 191 subjects without NIDDM, body mass index (BMI) was significantly higher in subjects homozygous for this mutation than in those homozygous for the normal allele (24.7 +/- 1.4 vs 22.1 +/- 0.2 kg/m2, p = 0.009). Moreover, the frequency of the mutant allele in obese subjects (BMI > 26.4) was significantly higher than that in non-obese subjects (BMI < 22) (0.37 vs 0.15, p = 0.009). The presence of this mutation was also accompanied by significantly higher fasting (p = 0.000) and 2 hrs (p = 0.018) serum insulin levels during an oral glucose tolerance test. The beta 3AR may be one of the loci contributing to obesity and hyperinsulinemia/insulin resistance in Japanese subjects.

[Clinical features of acute pulmonary embolism in the elderly]

The clinical features of acute pulmonary embolism were evaluated and compared between Group A with 38 cases > 65 years old and Group B with 73 cases < 65 years old. The mortality rate was 58% (22/38) in Group A and 23% (17/73) in Group B (p < 0.01). However the size of the obstructive pulmonary vascular bed showed no significant difference in both groups. In group A dyspnea was the most common symptom in 27 of 31 (87%), in comparison with group B [45 of 66 (68%), p < 0.05]. In group B, dyspnea and other symptoms appeared abruptly in 44 of 57 (77%), compared with 19 of 36 (53%) in group A (p < 0.02). ECG abnormalities including tachycardia, right bundle branch block and clockwise rotation as well as hypoxemia were present more predominantly in group A. The presentation of pulmonary embolism is variable in the elderly, as in any age group. Many autopsy studies showed a significant rise in incidence of pulmonary embolism in higher age groups. We must keep in mind the characteristics of clinical features in pulmonary embolism in the elderly.

Hemostatic abnormalities in patients with pulmonary embolism compared with that in deep vein thrombosis

We investigated hemostatic abnormalities in 37 patients with deep vein thrombosis (DVT) and pulmonary embolism (PE) (PE patients) and in 40 patients with DVT without PE (DVT patients). Plasma fibrinogen, thrombin-antithrombin complex (TAT), plasmin-plasmin inhibitor complex, fibrin-D-dimer, activated protein C (APC)-protein C inhibitor (PCI) complex, von Willebrand factor (vWf), tissue plasminogen activator (t-PA), PA inhibitor-I (PAI-1), and thrombomodulin levels in both PE and DVT patients were significantly increased compared with normal volunteers. Plasma APC-PCI complex, PAI-1, and vWf levels in PE patients were significantly higher than those in DVT patients without PE. These findings indicate that PE patients are more hypercoagulable and hypofibrinolytic than DVT patients. Plasma TAT, APC-PCI complex, PAI-1, and vWf levels were the most sensitive indicators for PE. In these patients, increases in TAT and APC-PCI complex suggest DVT and increased PAI-1 and vWf suggest the risk of onset of PE.

[Chronological analysis of eosinophil infiltration in mite-allergen induced dermatitis in atopic patients]

To elucidate the active process of eosinophil infiltration in atopic dermatitis (AD), we performed patch testing using crude mite allergens on normal-appearing skin in adult AD patients with high levels of mite-specific IgE antibodies and analyzed positive reaction sites chronologically by histological and immunohistological methods. Positive reactions were observed in 6 out of 9 AD patients (66.7%), whereas none of 7 non-AD control subjects showed positive reactions. Skin biopsies were obtained from positive reaction sites at 2,6,12,24 and 48 hours after allergen challenge. Eosinophils were seen within postcapillary venules at 2 hours, followed by increased perivascular eosinophil infiltration at 6 hours which peaked at 24 and 48 hours. Epidermal eosinophilic spongiosis was also observed at 48 hours. The majority of infiltrating eosinophils showed positive reactions for BMK-13 and 15-59% of them were EG2 positive activated eosinophils. BMK-13, EG2 and anti-EP positive reactions were scattered throughout connective tissue and their areas were time-dependently increased. These findings suggest that eosinophil transmigration and activation play an important role in initiating early AD lesions induced by transepidermal mite allergen permeation.