The endogenous insulin secretion was suppressed during insulin therapy in NIDDM patients

Urinary C-peptide excretion (U-C-peptide) was measured in order to examine the changes in endogenous insulin secretion after the beginning of insulin therapy. U-C-peptide in the 24-h urine (TU-C-peptide) of non-insulin-dependent diabetes mellitus (NIDDM) patients was measured on the 6,7,8th (period-A), 13,14,15th (period-B) and 20,21,22nd day (period-C) after admission. The TU-C-peptide of NIDDM patients, newly receiving insulin therapy from the 9th day, decreased to 58.7 +/- 6.2% (mean +/- SEM) of its basal level (period-A, 19.8 +/- 3.8 nmol/day) at period-B and remained at the same level at period-C, although U-C-peptide in the urine collected between 04.00 h and 06.30 h did not decrease significantly. Their plasma C-peptide levels from 2-5 h after the ingestion of a mixed meal at period-C decreased significantly compared with those at period-A. On the other hand, the TU-C-peptide of NIDDM patients who continued therapy with insulin or sulfonylureas in the outpatient clinic at period-B and -C did not decrease significantly from the basal level at period-A, although fasting plasma glucose decreased to the same level in both groups of patients. These results suggest that the endogenous insulin secretion after food ingestion is suppressed during insulin therapy in NIDDM patients.

Glucagon-like peptide-1(7-37) does not stimulate either hepatic glycogenolysis or ketogenesis

Recent Studies have demonstrated that glucagon-like peptide-1 (GLP)(7-37) has more potent insulinotropic activity than glucagon. We therefore examined the effect of GLP-1(7-37) on liver metabolism using rat liver perfusion system. Ten nM GLP-1(7-37) did not affect glucose, ketone body and cAMP outputs from the perfused liver. Whereas, the same dose of glucagon stimulated these outputs significantly. When 10 nM GLP-1(7-37) perfused 5 min before the administration of 10 nM glucagon, the above stimulatory effects of glucagon were not affected. These results indicate that truncated GLP-1 has no effect on hepatic glycogenolysis and ketogenesis dissociating from its potent insulinotropic activity.

Growth-inhibitory effects of epidermal growth factor on human breast cancer and carcinoma of the esophagus transplanted into nude mice

The present work was performed to clarify the effects of epidermal growth factor (EGF) on the growth of human breast cancer and carcinoma of the esophagus. Human breast cancer MX-1, UM-1, and esophageal cancer ES-4 were transplanted to the subcutaneous tissue of nude mice. Human EGF (2 micrograms) was injected locally into the subcutaneous tissue surrounding the tumor. The tumor growth was followed for 7 days after treatment, and the estimated tumor weight, tumor doubling time, tumor growth curve, tumor growth rate, and results from histologic examination were used to evaluate the effects of EGF on the growth of tumors. We investigated the dose effect on the growth of these tumors using various concentrations of EGF. We also studied the EGF receptor status of these transplanted tumors and its effect on the influence of EGF treatment. A growth-inhibitory effect was noted in these three tumors with 2 micrograms of EGF. EGF inhibited growth of ES-4 tumor in a dose-dependent manner. Treatment with 2 ng of EGF or saline did not inhibit growth. However treatment with 20 ng or 200 ng of EGF inhibited growth in proportion to the concentrations. All tumors were positive by the EGF receptor binding assay. The efficacy of EGF treatment correlated with EGF receptor levels. EGF receptor levels were also influenced by EGF treatment. These results suggest that human EGF showed an anti-tumor effect on MX-1 and UM-1 breast cancer and also on ES-4 esophageal cancer.

Association of elevated expression of the c-erbB-2 protein with spread of breast cancer

We analyzed amplification and expression of the c-erbB-2 gene in human breast cancers. Southern blot hybridization analysis demonstrated amplification of the c-erbB-2 gene in 10 out of 50 tumor DNAs examined. The degree of amplification was three- to twenty-fold relative to normal placenta. The c-erbB-2 protein could be analyzed in 39 tumor tissues of the 50 samples by immuno-blotting, and elevated expression of the c-erbB-2 protein was found in 15 cases. On the other hand, expression of the c-erbB-2 products was not detected in normal breast tissues either by immuno-blotting or by immuno-histological analysis. These data indicate that transcriptional and/or translational activation of c-erbB-2 might occur in some breast cancers in addition to activation by gene amplification. The elevated expression of the c-erbB-2 protein was most strongly correlated with lymph-node metastasis (P less than 0.001), suggesting that c-erbB-2 expression is involved in promotion of the lymph-node metastasis of human breast cancers. Therefore, immuno-histological diagnosis with anti-c-erbB-2 antibody might be useful as an indicator to predict lymph-node involvement in breast cancer.

A new method of modified radical mastectomy for breast cancer

We have developed a new type of modified radical mastectomy, the method and clinical results of which are reported herein. In this operation, axillary dissection is performed by the following two approaches. Firstly, the axillary contents are dissected from the highest possible subclavicular point to the pectoralis minor muscle, after partially cutting the sternocostal origin of the pectoralis major muscle. The second approach is from the posterior aspect of the pectoralis minor muscle to the lateral portion of the latissimus dorsi muscle. Parasternal dissection can also be performed for stage II and IIIa cancers with a central or medial tumor. After lymph node dissection, the detached edge of the sternocostal origin of the pectoralis major muscle is resutured to cover the parasternal region. Thus, complete dissection of the axillary nodes is performed whilst preserving the pectoralis major and pectoralis minor muscles. Good clinical results were achieved with respect to radicality, cosmetic effects and function in 28 patients with stage I, II, and IIIa breast cancers who were followed up for between 5 to 8 years. This new operation may therefore be adopted for the majority of patients with Stage I, II, or IIIa cancers, unless massive infiltration into the pectoralis major muscle has occurred. Preservation of both the pectoralis major and pectoralis minor muscles results in a good cosmetic appearance, good functioning of the arm and easy reconstruction of the breast following mastectomy.

Possible direct linkage of insulin-like growth factor-II receptor with guanine nucleotide-binding proteins

In mouse Balb/c3T3 fibroblasts, insulin-like growth factor (IGF)-II activates a calcium-permeable cation channel through a cell surface IGF-II receptor (Kojima, I., Nishimoto, I., Iiri, T., Ogata, E., and Rosenfeld, R. G. (1988) Biochem. Biophys. Res. Commun. 154, 9-19; Matsunaga, H., Nishimoto, I., Kojima, I., Yamashita, N., Kurokawa, K., and Ogata, E. (1988) Am. J. Physiol. 255, C442-C446). In the action of IGF-II, a pertussis toxin (or islet-activating protein; IAP)-sensitive GTP-binding protein (G protein) is inferred to be involved (Nishimoto, I., Hata, Y., Ogata, E., and Kojima, I. (1987) J. Biol. Chem. 262, 12120-12126). In the present study, we examined the direct coupling of the IGF-II receptor with G proteins. In broken Balb/c3T3 cell membranes, 10 nM IGF-II rapidly attenuated the IAP-catalyzed ADP-ribosylation of a 40-kDa protein in a manner requiring magnesium ion. The IGF-II-mediated attenuation in the IAP substrate activity was 80% recovered after washing off IGF-II and inhibited by coexisting guanosine 5'-O-(2-thiodiphosphate), while either aluminum fluoride solution (10 mM NaF plus 100 microM AlCl3) or 100 microM guanosine 5'-O-(3-thiotriphosphate) (GTP gamma S) reproduced the action of IGF-II. When purified IAP substrate G proteins (Gi1, Gi2, G0) were incubated with IGF-II in the presence of membranes from IAP-treated Balb/c3T3 cells, the attenuation in the IAP substrate activity was evident in Gi2, but not in Gi1 or G0. On the other hand, 10 nM insulin had no effect on the modification of the 40-kDa IAP substrate in Balb/c3T3 cell membranes, whereas 10 nM IGF-I elicited a slow onset of the IAP sensitivity attenuation from the 40-kDa protein. However, the specific involvement of the IGF-II receptor in the modification of the IAP substrate induced by low concentrations of IGF-II was suggested by the observations that (i) IGF-I receptor-lacking cell membranes were effective for the Gi2 modification by IGF-II, (ii) the ability of membranes to mediate the action of IGF-II was markedly attenuated in IGF-II receptor-lacking cell membranes, and (iii) agonistic anti-IGF-II receptor antibody mimicked the action of IGF-II on the 40-kDa protein in Balb/c3T3 cell membranes in a dose-dependent manner similar to that observed in the antibody-induced blocking of membrane IGF-II binding.(ABSTRACT TRUNCATED AT 400 WORDS)

[Basic studies on the measurement of bone mineral content of mandible by quantitative computed tomography]

The basic studies were made in order to apply Quantitative Computed Tomography (QCT) to the measurement of mandibular bone mineral content. On the basis of the results, the bone mineral contents of the periapical region of the mandibular alveolar bone was measured in 10 normal subjects (5 male and 5 female: aged in their 20's). The obtained results were as follows. (1) The changes in CT numbers for 12 weeks under the same conditions of scanning were stable within the level of 1.0H.U. standard deviation. (2) The standard deviation of CT numbers obtained from the experiment with variable field sizes was under 14.5H.U.. The standard deviation of CT numbers obtained from experiments with subjects on various degrees of X-ray absorption was under 49.2H.U.. These results showed that CT numbers were considered to be unsatisfactory for use as a quantitative parameter. (3) The linearity of CT numbers and K2HPO4 liquid density was estimated by correlation coefficient. The linearity was proved to have a good correlation coefficient, above 0.999. And the correction made using a K2HPO4-QCT phantom considered to have a sufficient accuracy. (4) The accuracy of the measurement of the bone mineral density of the mandibular was estimated to be +/- 3.9mg/ml K2HPO4eq using a QCT phantom. (5) The bone mineral density of the total alveolar bone, the cortical and the spongy bone in the periapical region from premolar to molar was 503.5 +/- 55.7, 771.4 +/- 52.7 and 198.4 +/- 69.0mg/ml K2HPO4eq respectively. (6) No significant differences in bone mineral density depending on the location or sex were observed. (7) Significant differences in bone mineral surface density depending on the location were observed. The value was higher in molar than in premolar regions. But no significant difference between sexes was observed.

Cell surface protein antigen from Wolinella recta ATCC 33238T

A high-molecular-weight (approximately 150,000) protein was selectively isolated by acid extraction from the cell surface of Wolinella recta and purified by negative adsorption on DEAE-cellulose and gel filtration. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis analysis showed that this protein was found in W. recta but not in other Wolinella species, such as W. curva and W. succinogenes. Sera from patients with periodontitis reacted strongly with this protein antigen, whereas sera from healthy donors showed little or no reactivity, as determined by immunoblotting analysis. In serum, titers of immunoglobulin G antibodies to the protein antigen were significantly higher in patients with periodontitis than in periodontally healthy donors, as detected by an enzyme-linked immunosorbent assay.

Insulin and glucagon secretion are suppressed equally during both hyper- and euglycemia by moderate hyperinsulinemia in patients with diabetes mellitus

Hyper- and euglycemic clamp studies were performed in patients with noninsulin-dependent diabetes mellitus to examine the effects of exogenous insulin administration on insulin and glucagon secretion. Plasma glucose was kept at the fasting level [mean, 10.0 +/- 0.2 (+/- SE) mmol/L; hyperglycemic clamp], and graded doses of insulin (1, 3, and 10 mU/kg.min, each for 50 min) were infused. The plasma C-peptide level gradually decreased from 523 +/- 66 to 291 +/- 43 pmol/L (n = 13; P less than 0.005) by the end of the hyperglycemic clamp study. After 90 min of equilibration with euglycemia (5.4 +/- 0.1 mmol/L; euglycemic clamp), the same insulin infusion protocol caused a similar decrease in the plasma C-peptide level. With the same glucose clamp protocol, physiological hyperinsulinemia for 150 min (676 +/- 40 pmol/L), obtained by the infusion of 2 mU/kg.min insulin, caused suppression of the plasma C-peptide level from 536 +/- 119 to 273 +/- 65 pmol/L during hyperglycemia and from 268 +/- 41 to 151 +/- 23 pmol/L during euglycemia (n = 9; P less than 0.005 in each clamp). Plasma glucagon was suppressed to a similar degree in both glycemic states. These results demonstrate that 1) insulin secretion in non-insulin-dependent diabetes mellitus is suppressed by high physiological doses of exogenous insulin in both the hyper- and euglycemic states, the degree of inhibition being independent of the plasma glucose level; and 2) glucagon secretion is also inhibited by such doses of exogenous insulin.

Comparison of the effects of glucagon-like peptide-1-(1-37) and -(7-37) and glucagon on islet hormone release from isolated perfused canine and rat pancreases

Recently, it has been demonstrated that glucagon-like peptide-1 (GLP-1)-(7-37) possesses a potent insulinotropic activity. In this paper, we compared the effects of GLP-1-(1-37) and -(7-37) and glucagon on insulin, glucagon, and somatostatin release from isolated perfused canine and rat pancreases under the perfusate condition of 5.5 mM glucose plus arginine. With canine pancreas perfusion, 1 nM GLP-1-(7-37) was more potent in stimulating insulin and somatostatin release than was the same dose of glucagon [stimulation to 375 +/- 36% vs. 302 +/- 28% of the basal level for insulin (P less than 0.05); 724 +/- 129% vs. 311 +/- 33% of the basal level for somatostatin (P less than 0.01)]. GLP-1-(1-37) (1 nM) did not stimulate either insulin or somatostatin release. GLP-1-(7-37) (1 nM) decreased the glucagon level of the effluent perfusate to 67.2 +/- 3.4% of its basal level; but 1 nM GLP-1-(1-37) did not. Glucagon (1 nM) decreased GLP-1-like immunoreactivity to 64.0 +/- 5.2% of its basal level. With rat pancreatic perfusion, the minimal dose for stimulation of insulin release was 100 nM for GLP-1-(1-37), 0.1 nM for GLP-1-(7-37), and 1 nM for glucagon, respectively. Glucagon release was partially inhibited by 100 nM GLP-1-(1-37) and 1 and 10 nM GLP-1-(7-37). The present results indicate that 1) since GLP-1-(7-37) is released from the intestine, it might be an important incretin candidate along with gastric inhibitory peptide; and 2) the release of proglucagon-derived peptides from pancreatic A-cells is regulated by autofeedback through glucagon and GLP-1.

[Periodontal tissues and sex hormones. Effects of sex hormones on metabolism of fibroblasts derived from periodontal ligament]

Sex hormones are closely related to the onset and progression of periodontal disease. The purpose of this study was to evaluate the effects of sex hormones on the metabolism of human periodontal ligament cells. Human periodontal ligament cells and gingival fibroblasts were prepared from 7 donors with normal gingiva. 17 beta-estradiol and progesterone were purchased from Sigma Chemical Company. The effects of sex hormones on cell morphology, alkaline phosphatase activity, cell proliferation, DNA synthesis, collagen synthesis and non-collagenous protein synthesis were investigated. The results were as follows: 1. Periodontal ligament cells showed osteoinductive-like cells in the cell morphology and alkaline phosphatase activity. 2. DNA synthesis was stimulated by 17 beta-estradiol and progesterone in the presence of 5% fetal calf serum. 3. Collagen synthesis was inhibited by 17 beta-estradiol and progesterone, while non-collagenous protein synthesis was inhibited by 17 beta-estradiol and low concentrations of progesterone. 4. The addition of serum into culture medium was necessary to induce the basic metabolism of human periodontal ligament cells. It was demonstrated that sex hormones are closely related to the metabolism of human periodontal ligament cells.

Hyperglucagonemia of insulin autoimmune syndrome induced by methimazole in a patient with Graves' disease

A 47-year-old man with Graves' disease suffered from a feeling of hunger and sweating in the night, polyarthralgia and fever one month after the start of treatment with methimazole. The above symptoms were ascribed to the side effects of methimazole; insulin autoimmune syndrome and lupus-like syndrome. The change in the antithyroid drug to propylthiouracil caused an amelioration of the symptoms. In addition to an anti-insulin antibody with a high binding capacity, hyperglucagonemia (260 pg/ml with a plasma glucose level of 61 mg/dl) was observed, which returned to normal in parallel with the decrease in the insulin binding capacity of the plasma one month after beginning the treatment with propylthiouracil. A normal decrease in the plasma glucagon level due to exogenous insulin (2 mU/kg/min) was observed with the euglycemic clamp. However, the plasma glucagon level was not suppressed by the oral glucose loading and elicited a poor response to the arginine infusion. Taking previous reports into account, this basal hyperglucagonemia seems to be a characteristic finding in the insulin autoimmune syndrome, while a sluggish response of glucagon to oral glucose or arginine infusion might be ascribed to hyperthyroidism. This is the first case report concerning a kinetical study of the glucagon secretion in insulin autoimmune syndrome with Graves' disease.

Serum immunoglobulin G antibody to periodontal bacteria

The purpose of this study was to assess the serum antibody levels to periodontal bacteria in patients with periodontal disease, and to explore the diagnostic uses of the serum antibody assessment and its potential as a therapeutic guide.

One hundred twenty-nine patients were clinically examined for the type and extent of periodontal destruction and serum IgG antibody levels to Actinobacillus actinomycetemcomitans (Aa), Actinomyces israelii (Ai), A. viscosus (Av), Bacteroides asaccharolyticus (Ba), B. corporis (Bc), B. denticola (Bd), B. gingivalis (Bg), B. intermedius (Bi), B. loescheii (BI), Capnocytophaga gingivalis (Cg), C. ochracea (Co), and Fusobacterium nucleatum (Fn). Clinical and serological data were subjected to correlation analyses. A small group of patients was monitored during the progress of periodontal treatments.

The IgG antibody levels were assessed with an enzyme-linked immunosorbent assay (ELISA).

Significantly elevated IgG antibody levels were manifested to Aa, Ai, Bg, and Fn in all forms of periodontal disease, additionally to Cg and Co in juvenile periodontitis, and to Bi in adult periodontitis. There were some correlations between a few clinical parameters and the antibody levels. Successful periodontal treatment significantly decreased the antibody levels to all of the micro-organisms; however, during periodontal treatment, there were no marked differences between pre- and post-treatment levels.

The antibody reactivities to the periodontopathic micro-organisms may be of diagnostic and predictive value in patients.

Neutrophil functions in patients with severe periodontal disease

Recently several investigators have reported that neutrophil functions were depressed or defective in localized and generalized juvenile periodontitis. It has also been shown that patients with adult periodontitis exhibit no such abnormalities. Concerning rapidly progressing periodontitis, only a few reports have been provided. The purpose of the present study was to compare various neutrophil functions in patients with rapidly progressing periodontitis (RPP), generalized adult periodontitis (AP), and in periodontally healthy or control subjects.

Neutrophils and monocytes were obtained from heparinized peripheral blood of 13 RPP, 16 AP, and 18 control subjects. Cells were isolated by Percoll® discontinuous density gradient centrifugation. Neutrophil phagocytosis was examined by use of FITC-labeled bacteria, and the number of EA rosette-forming cells was determined. Random migration and chemotaxis of neutrophils and monocytes were evaluated with the Boyden chamber. In addition, opsonizing activity of plasma, effects of plasma on phagocytosis and chemotaxis, and lysosomal enzyme secretion were also determined.

Neutrophil phagocytosis was markedly depressed in RPP compared with AP and those with normal periodontal tissue. The number of phagocytizing neutrophils was decreased and seemed to be correlated with the number of EA rosette-forming cells. Random migration and chemotaxis of neutrophils and monocytes were not significantly different among these three study groups. No differences in other neutrophil functions could be found.

From these results, it was clear that neutrophil phagocytosis in RPP patients was depressed. These results suggest that neutrophil abnormalities may lead to decreased resistance to periodontal infections in adults with rapidly progressing forms of periodontal disease.

A pulsatile pump for cardiopulmonary bypass and its clinical use

A pulsatile pump driven by a coil spring, which was designed and constructed by us, is described in this report. It consists of two main parts, a disposable blood chamber and a driving section. The blood chamber has two leaflet valves and a piston, which is covered with two bellofram rolling diaphragms and moves into the housing to draw in and eject the blood. The driving section consists of three cams, an electric motor and a coil spring. The ejection force is wholly produced by the compressed coil spring and is transmitted to the piston in the blood chamber by a rod. This pump allows the ejection pressure, the beat rates, and the stroke volume all to be changed independently. The performance of the pump was tested by using a circulation model where the beat rate was adjusted from 30 to 250 bpm. The output subsequently increased from 0.8 l/min to 5.7 l/min and the stroke volume, from 20.4 ml to 36.7 ml. This new pump has been used for clinical cardiopulmonary bypasses in 24 patients of open heart surgery and the pressure traces during perfusion resembled those of the patients' own hearts.

Reduction of the antigenicity and immunogenicity of xenografts by a new cross-linking reagent

To overcome the disadvantages of glutaraldehyde (GA), new cross-linking reagents, polyepoxy compounds (PC), were introduced and their effects on the antigenicity and immunogenicity of biomaterials were investigated. In the qualitative study, antigenicity of type I collagen in bovine arteries treated with GA or glycerol polyglycidyl ether (GPE), a kind of PC, was detected using a fluorescent antibody technique. To evaluate the immunogenicity quantitatively, DDY mice were twice immunized with homogenates of GA, GPE, or untreated dog arteries. Using their sera collected 10 and 90 days after the last immunization as primary antibodies, the dogs' peripheral lymphocytes were stained with FITC labeled anti-mouse IgG antibodies against shared antigens on arteries and lymphocytes. Percentages of stained lymphocytes were then analyzed with flow cytofluorometry. In both qualitative and quantitative studies, extremely low antigenicity and immunogenicity were shown in GA or GPE treated arteries. It is therefore suggested that GPE is an ideal cross-linking reagent for vascular and valvular xenografts and is applicable to clinical use.