Enhancement of pressor response to ephedrine following clonidine medication

We studied pressor responses and changes in plasma catecholamine concentrations following two consecutive doses of ephedrine 0.1 mg.kg-1 with (n = 20) and without (n = 20) clonidine 5 micrograms.kg-1 premedication in patients presenting for a variety of major surgical procedures under general anaesthesia. Arterial blood pressure and heart rate were measured at 1 min intervals for 10 min, and plasma catecholamines were measured before and 3 min after each dose of ephedrine. Mean blood pressure changes from the baseline values were greater in the clonidine than in the control group 3-8 min and 4-9 min following the first and the second doses of ephedrine, respectively (p < 0.05). Plasma catecholamine concentrations tended to be lower in the clonidine group throughout the study. The augmented pressor response to ephedrine in clonidine-treated patients can be attributed to enhanced cardiovascular response rather than clonidine-induced accumulation and subsequent increased release of catecholamine.

Kalimantacin A, B, and C, novel antibiotics produced by Alcaligenes sp. YL-02632S. II. Physico-chemical properties and structure elucidation

Kalimantacin A, B and C are new antibiotics produced by Alcaligenes sp. YL-02632S. Their structures were elucidated to be novel long chain structure compounds containing O-carbamoyl, amide and carboxylic acid moieties based on various 2D NMR experiments and MS analysis.

A case of linear IgA bullous dermatosis with IgA anti-type VII collagen autoantibodies

In this study we present a patient with the sublamina densa type of linear IgA bullous dermatosis (LABD), with IgA autoantibodies reactive with the 290-kDa type VII collagen (the epidermolysis bullosa acquisita (EBA) antigen) and with immunoblotting of normal human dermal extracts. The clinical and histological features of the present case were compatible with those of LABD but quite different from those of EBA. Although EBA sera reacted with the bacterial fusion protein of the N-terminal globular (NC1) domain of type VII collagen, this patient's serum did not show reactivity. Furthermore, ultrastructural localization of target epitopes on the anchoring fibrils in this patient was considerably different from EBA. These results indicate that, whereas EBA antibodies react with the NC1 domain of type VII collagen, the epitope in this case is different from that of EBA (and is most likely on the central triple helical domain). This difference may be responsible for the clinical presentation in this patient being distinct from that of EBA.

On-column isomerization of sugars during high-performance liquid chromatography: analysis of the elution profile

Four monosaccharides (glucose, galactose, mannose and fructose) and one disaccharide (maltose) were subjected to high-performance liquid chromatography with UV or refractive index detection. Various profiles such as broad, tailed and splitted peaks were produced, depending on column temperature and eluent flow-rate because these saccharides underwent isomerization. In contrast, alpha-methylglucoside, a non-converting derivative, always produced a sharp peak. By analyzing these profiles kinetic constants of the isomerization were obtained and compared with the literature data.

Molecular basis of recessive dystrophic epidermolysis bullosa: genotype/phenotype correlation in a case of moderate clinical severity

Mutations within the gene encoding the anchoring fibril protein type VII collagen (COL7A1) have recently been established as the pathogenetic basis for the inherited blistering skin disorder, dystrophic epidermolysis bullosa. We report a patient with a moderately severe phenotype of recessive dystrophic epidermolysis bullosa. We report a patient with a moderately severe phenotype of recessive dystrophic epidermolysis bullosa, in whom COL7A1 mutations have been identified on both alleles. The patient is a 5-y-old Japanese male of nonconsanguineous parents, with clinical features including generalized trauma-induced blistering since birth, complete loss of nails, and partial fusion of the fingers and toes. Immunofluorescence microscopy examination of the dermal-epidermal junction in the patient's skin revealed near-normal intensity staining with an antitype VII collagen antibody (LH7:2). Transmission electron microscopy showed a reduced number of thin, poorly-formed anchoring fibrils. PCR amplification of genomic DNA, followed by heteroduplex analysis, and nucleotide sequencing demonstrated that the patient was a compound heterozygote for a nonsense mutation (E2858X) within the NC-2 domain of type VII collagen and a missense mutation (G2576R) within the type VII collagen triple helix. Both mutations were verified by restriction endonuclease digestion. Information about these mutations advances our understanding of genotype-phenotype correlations in dystrophic epidermolysis bullosa, and further delineates the mechanisms involved in dermal-epidermal dysadhesion.

Mycosis fungoides with marked hyperpigmentation

Pigmentary changes in mycosis fungoides are not rare. Although poikiloderma and hypopigmented skin lesions have often been reported in the literature, there are few cases of mycosis fungoides presenting as a hyperpigmented skin lesion. We present a 57-year-old Japanese male with mycosis fungoides whose skin lesions showed marked hyperpigmentation. The skin lesion initially appeared as an irregularly shaped itchy annular erythema with central pigmentation predominantly on his extremities. During our 5-year follow-up, these skin lesions gradually increased in size and number. The erythema extended peripherally and became elevated with marked hyperpigmentation. Histology revealed extreme elongation of the rete ridges with infiltration of atypical large lymphoid cells characteristic of mycosis fungoides and numerous melanin granules in both the epidermal melanocytes and dermal melanophages. Although the exact mechanism of the marked hyperpigmentation is one of the unique characteristics in mycosis fungoides, especially in non-white individuals.

Kynurenine aminotransferases in the rat. Localization and characterization

Kynurenine-2-oxoglutarate aminotransferase (kynurenine specific, designated here KAT-II) and kynurenine pyruvate aminotransferase (designated here KAT-I) activities were detected in the kidney using 2 microM kynurenine. The major activities were performed by KAT-II and the contributi-n of KAT-I is about 1/15. KAT-I activity was detected in all organs tested. The liver showed the highest KAT-I activity, however, the highest activity of glutamine transaminase-K (GTK) was detected in the kidney. KAT-I activity was well corresponded with GTK activity in all organs except liver. KAT-I or GTK activity of crude extract didn't inhibited by addition of glutamine either kynurenine. KAT-I or GTK activity of purified preparation, however, inhibited strongly addition of glutamine either kynurenine. KAT-I and GTK showed different pH optimum profile, but purified and crude preparation of those were similar. Phenylpyruvate or 2-oxo-4-methiolbutyrate reduced the inhibition of purified KAT-I activity by glutamine using 2 microM kynurenine. Phenylpyruvate changed the Km value for kynurenine and Vmax, suggesting conformational change of the enzyme.

A case of silent 21-hydroxylase deficiency with persistent adrenal insufficiency after removal of an adrenal incidentaloma

A case of an adrenal incidentaloma in a 57-year-old man with silent 21-hydroxylase deficiency is reported. Abdominal computed tomography revealed a right adrenal tumour of 6cm in diameter. There was no evidence of adrenal hormone excess. However, after surgical removal of the adrenal tumour, the patient developed acute adrenal insufficiency. Adrenocortical function has remained low ever since surgery. Pathological examination of the tumour revealed a cortical adenoma. On the basis of increased plasma renin activity and serum 17 alpha-hydroxyprogesterone concentration and decreased 21-hydroxylase activity of the adenoma tissue, the patient was diagnosed as having systemic 21-hydroxylase deficiency. There are two possible mechanisms for the persistent adrenal insufficiency; first the residual left adrenal gland may have been originally hypo-functioning for some reason and, second, the left gland may have lost the ability to regenerate following prolonged suppression by the adenoma. In cases of adrenal incidentalomas with 21-hydroxylase deficiency, the indications for surgical removal should be carefully considered.

Borrelia burgdorferi sensu lato in an endemic environment: wild sika deer (Cervus nippon yesoensis) with infected ticks and antibodies

Ticks and blood samples were collected from wild sika deer (Cervus nippon yesoensis) during a hunting season (August to October) of 1991 at a selected location in Hokkaido, Japan. Ixodes persulcatus (adult and nymph) and I. ovatus (adult) were the common ticks on sika deer. Spirochetes were detected in the midgut of the ticks by the indirect peroxidase-conjugated antibody staining method and by dark-field microscopy after cultivation. By the reactive pattern of monoclonal antibodies, isolates were considered to belong to Borrelia garinii or B. japonica. In an antibody test, the percentage of seropositive deer was 69.0%. Most of the adult sika deer were positive for antibodies to the spirochetes. There are significant age-dependency in antibody level and seropositive rate. The surveillance of deer should be valuable in monitoring the transmission risk of B. burgdorferi sensu lato in nature.

Cutaneous chronic graft-versus-host disease localized to the field of total lymphoid irradiation

A 20-year-old woman with aplastic anemia underwent bone marrow transplantation from an HLA-identical sibling after total lymphoid irradiation (TLI) and cyclophosphamide (CY). The post-transplant course was uneventful. CYA was discontinued on day 221. Three weeks later, the patient developed cutaneous GVHD precisely localized to the field of TLI. No other organs were involved. Immunohistochemical staining of the affected skin was strongly positive for ICAM-1, PECAM-1 and ELAM-1; normal skin was only weakly positive for ICAM-1. CYA was restarted, and the skin lesions disappeared. TLI may contribute to an unusual presentation of cutaneous GVHD associated with specific expression of adhesion molecules.

Apoptosis and DNA fragmentation in the bulbus cordis of the developing rat heart

Histologic, ultrastructural and nick end labeling studies were made of the process of apoptosis in the bulbus cordis of rat embryos. Apoptosis was observed between the 14th and 16th days of gestational age, at which time the bulbus cordis undergoes extensive remodeling. Three types of mesenchymal cells were identified in this region: cells undergoing apoptosis, cells engaging in the phagocytic removal of apoptotic cells, and cells not involved in either of these two processes. Fragmentation of DNA, demonstrated by nick end labeling, was found only in the apoptotic cells. The combined use of morphologic and labeling techniques is extremely useful in the evaluation of the contribution of apoptosis to cardiac morphogenesis.

Reticular erythematous mucinosis syndrome: glycosaminoglycan synthesis by fibroblasts and abnormal response to interleukin-1 beta

BACKGROUND

Reticular erythematous mucinosis (REM) syndrome is characterized by an accumulation of mucin in the dermis.

OBJECTIVE

To elucidate the mechanism of mucin deposition, the response of REM syndrome fibroblasts to various exogenous factors was studied.

METHOD

REM and control fibroblasts were treated with potent modulators including tumor necrosis factor-alpha, basic fibroblast growth factor, interferon-gamma, transforming growth factor-beta 1 and interleukin-1 alpha (IL-1 alpha) and -4.

RESULTS

IL-1 beta failed to stimulate glycosaminoglycan synthesis in REM fibroblasts whereas it stimulated glycosaminoglycan synthesis up to 6-fold in control fibroblasts. The stimulation of glycosaminoglycan was caused largely by a comparable increase in hyaluronic acid.

CONCLUSION

These results suggest that the patient fibroblasts exhibit an abnormal response to stimulation by exogenous IL-1 beta and that IL- 1 beta may be involved in the abnormal hyaluronic acid metabolism in REM syndrome.

Clinical manifestations in 100 Japanese bullous pemphigoid cases in relation to autoantigen profiles

The relationship between clinical findings and antigen profiles in 100 bullous pemphigoid (BP) patients has been investigated. The patients were divided into four groups based upon the results of immunoblot analysis, namely patients whose sera detected the 230-kDa BP antigen (BP230) and the 180-kDa BP antigen (BP180), those recognizing either BP230 or BP180 alone, and those recognizing neither antigen. Analysis by the chi-squared test showed predominant occurrence of oral (P < 0.05) and facial lesions (P < 0.005) in patients whose sera detected BP180, and these patients also tended to have more extensive lesions (P < 0.005). Patients that were positive for BP180 alone needed treatment with higher doses of steroids than the patients positive for BP230 alone (P < 0.05). Furthermore, all five recalcitrant cases, which did not respond well to steroid treatment, were shown to possess autoantibodies against BP180 in their sera. Patients with antibodies to BP230 had a tendency to have a high titre of anti-BMZ antibodies (P < 0.005). These results suggest that anti-BP180 antibodies may be more related to the disease severity than anti-BP230 antibodies. Bullous pemphigoid (BP) is an autoimmune blistering disorder characterized clinically by tense blister formation and immunologically by the presence of tissue-bound and circulating antibasement membrane zone (BMZ) autoantibodies. A number of immunoblot analyses have indicated that two major antigenic proteins of epidermal extracts, the 230-kDa BP antigen (BP230 or BPAG1) and the 180-kDa BP antigen (BP180, BPAG2 or type XVII collagen), are detected by sera from patients with BP in various patterns. Some BP sera recognize both antigen proteins, while others detect only BP230 or BP180 or none. Recently, cDNAs for these antigens have been isolated, and the characteristics for these molecules have been investigated in more detail. The exact relationship between these two proteins is still unclear; however, more recent studies showed that BP180 has an extracellular domain and polyclonal rabbit antibodies raised against an extracellular non-collagenous domain of the murine BP180 antigen were pathogenic in a passive transfer model. Several investigators have suggested a relationship between clinical findings and laboratory data in BP. Arbesman et al. compared the extent and duration of the disease with age, serum levels of IgE, IgA and IgG and titre of anti-BMZ antibodies. The results indicated that serum level of IgE and IgA correlated significantly to the extent of the disease and that titre of anti-BMZ antibodies correlated significantly (only in males) to the duration. There has been only one report which has analysed the relationship between pemphigoid antigens and clinical findings or laboratory data; no correlation was found. In a previous study, the reactivities of BP sera by immunoblotting using human epidermal extracts and two recombinant polypeptides produced from a mouse cDNA clone BPM1 were examined. The results of immunoblotting using epidermal extracts revealed that the two major BP antigens, BP230 and BP180, were detected by 74% and 51% of BP sera, respectively. Comparison of the clinical data with BP antigens gave the impression that the cases whose sera reacted only with BP180 were clinically more severe and less respondent to steroid treatment than the cases which detected BP230 alone on immunoblots. In the study reported here we have examined further the relationship between clinical and immunoblot data by applying a statistical analysis to the results previously obtained.

Epidermolysis bullosa acquisita: report of a case with comparison of immunogold electron microscopy using pre- and postembedding labelling

A patient with epidermolysis bullosa acquisita (EBA), who has been diagnosed as having bullous pemphigoid for 7 years, is reported. By immunoblotting, both the latest serum and a 4-year-stored serum sample of the patient, were shown to react with the 290-kDa EBA antigen or type VII collagen, but not with bullous pemphigoid antigens. Pre-embedding immunogold electron microscopy demonstrated that the serum bound to the 'anchoring plaque' and to both ends of the anchoring fibrils in the fashion reported previously. In contrast, postembedding immunoelectron microscopy showed binding mainly to the lamina densa. These results indicate that EBA antigens are localized mainly at the lamina densa. Further studies are necessary for confirmation.

Immunolocalization of human gelatinase (type IV collagenase, MMP-9) and tissue inhibitor of metalloproteinase 1 in Hailey-Hailey and Darier's diseases

BACKGROUND

The formation of lacunae and acantholysis as well as dyskeratosis are characteristic features of Hailey-Hailey disease (HHD) and Darier's disease (DD). Matrix metalloproteinases (MMPs) and their inhibitors like tissue inhibitors of metalloproteinases (TIMPs) have been thought to play major roles in the tissue metabolism.

OBJECTIVE

The aim of this study was to investigate the role of MMP-9 and TIMP-1 in HHD and DD.

METHODS

We examined localizations of these two molecules by immunostaining using specific monoclonal antibodies.

RESULTS

MMP-9 was positively stained in dyskeratotic or detaching cells around lacunae in HHD and DD. TIMP-1 showed a positive staining pattern throughout the epidermis.

CONCLUSION

MMP-9 might be involved in the pathophysiological process of HHD and DD in the presence of TIMP-1.

Heterogeneous reactivity with LH7.2 and the first prenatal diagnosis of generalized recessive dystrophic epidermolysis bullosa among Japanese patients

BACKGROUND

The heterogeneity of abnormal patterns of expression of type VII collagen in the skin of Japanese patients with generalized recessive dystrophic epidermolysis bullosa (g-RDEB) remains unclear, and the prenatal diagnosis of this condition has not yet been performed in Asia.

OBJECTIVE

The present study was performed to clarify patterns of abnormal expression of type VII collagen among Japanese patients with g-RDEB, and to evaluate the first application of prenatal diagnosis for this condition in an Asian country.

METHODS AND RESULTS

Only 2 of 8 Japanese patients with g-RDEB evaluated demonstrated a complete absence of type VII collagen at the skin basement membrane zone when tested with an LH7.2 monoclonal antibody. The other 6 patients revealed present, although diminished, LH7.2 reactivity. The mother of 1 patient who lacked reactivity to the LH7.2 monoclonal antibody sought prenatal diagnosis. Electron microscopy of fetal skin specimens obtained at 19 weeks' gestation showed mature anchoring fibrils with no separation of the dermis and epidermis. Indirect immunofluorescence revealed normal expression of type VII collagen. The fetus was diagnosed as being unaffected, and a normal female infant was delivered at 38 weeks' gestation.

CONCLUSION

Our findings indicate a lower incidence of the negative expression of LH7.2 epitope in the type VII collagen among Japanese rather than non-Japanese patients with g-RDEB. However, LH7.2 still serves as a reliable diagnostic probe under certain conditions such as the diagnosis and prenatal diagnosis of g-RDEB as in the present case.

A case of herpetiform pemphigus associated with autoimmune hemolytic anemia: detection of autoantibodies against multiple epidermal antigens

We report a case who was clinically and histopathologically diagnosed as herpetiform pemphigus (HP) and associated with autoimmune hemolytic anemia (AIHA). However, immunofluorescence studies demonstrated concurrent anti-cell-surface and anti-basement-membrane-zone antibodies in the patient's serum. Immunochemical studies showed that the patient's serum reacted with both the pemphigus foliaceus antigen and the two bullous pemphigoid antigens. Subsequently, the patient developed AIHA. Both anemia and skin lesions were successfully treated with oral prednisolone. We believe that this is the first case with HP in association with AIHA. The presence of autoantibodies against multiple antigens suggests an abnormal immunologic tolerance in the antibody production system in this patient.

Inhibition of purified (Na+,K+)-ATPase activity from porcine cerebral cortex by NO generating drugs

We tested the effects of several nitric oxide (NO) generating compounds on the activity of sodium-potassium adenosine 5'-triphosphatase [(Na+,K+)-ATPase] purified from porcine cerebral cortex. Sodium nitroprusside (SNP), S-nitroso-N-acetylpenicillamine (SNAP), 3-morpholinosydnonimine (SIN-1) and (d1)-(E)-ethyl-2-[(E)-hydroxyimino]-5-nitro-3-hexeneamide (NOR 3) inhibited the (Na+,K+)-ATPase activity dose dependently. Superoxide dismutase, a NO scavenger, and sulfhydryl (SH) compounds, reduced-form glutathione (rGSH) and dithiothreitol (DTT), prevented the inhibitory action of SNAP, SIN-1 and NOR 3 but not of SNP, when applied simultaneously with NO generating compounds, and this enzyme inhibition could be reactivated by the incubation with these SH compounds but not with SOD. The inhibitory action by SNP was magnified by simultaneous application of DTT. These results suggest that NO generating compounds, SNAP, SIN-1 and NOR 3 but not SNP, may release NO or NO-derived products and may inhibit (Na+,K+)-ATPase activity by interacting with a SH group at the active site of the enzyme.

Dystrophic form of inherited epidermolysis bullosa in a dog (Akita Inu)

We report a dog with dystrophic epidermolysis bullosa. This 4-year-old female Akita Inu, a species of Canis familiaris var. japonicus Temminck, had a 3-year-history of ulcers and scars over the pressure areas on the limbs, and dystrophic nails, since the age of 1 year, which corresponds to early adulthood in humans. Electron microscopy of a blister revealed separation beneath the lamina densa, and a reduction in the number of anchoring fibrils. The NC-1 domain of type VII collagen was positively stained with monoclonal antibody LH7.2 at the basement membrane zone. These findings indicate that humans and dogs have a similar response to antibody LH7.2, which may aid the development of an animal model for this disease.

T cell response to Borrelia garinii, Borrelia afzelii, and Borrelia japonica in various congenic mouse strains

The infectivity and T cell response to Borrelia garinii SIKA2, Borrelia afzelii BFOX, and Borrelia japonica 0612, the organisms that cause Lyme disease in Japan, were examined in various inbred and congenic strains of mice. Infectivity differed among the species: B. garinii SIKA2 and B. afzelii BFOX were each able to infect 90% to 100% of C3H/He mice; B. japonica 0612 was able to infect only 20% of C3H/He mice. The pattern of infectivity to various inbred and congenic strains of mice may influence the pathogenicity of the organism and the clinical signs of Lyme disease. Cross-reactivity between Borrelia antigens was observed, but there was no cross-reactivity between Borrelia antigens and Leptospira antigens. We evaluated the genetic control of the delayed-type hypersensitivity (DTH) reaction in the form of footpad swelling produced by Borrelia antigens using viable or sonicated bacteria as sensitization. Differences in strains of mice infected by viable antigen were observed. However, all strains of mice showed a strong DTH reaction using sonicated antigens without genetic background. A DTH reaction in the form of footpad swelling did not appear to be associated with genetic background. The footpad reaction was mediated by CD4+8- and Ia- T cells, as revealed by in vitro monoclonal antibody treatment. However, CD8+ T cells did not suppress footpad swelling. These results indicate that many antigenic epitopes of the Borrelia spirochete can stimulate the DTH reaction.

Endotoxin induces severe inflammatory reactions with necrosis at sites primed with delayed-type hypersensitivity reactions in guinea pigs

Guinea pigs immunized with Freund's complete adjuvant received challenge injection of the purified protein derivative of Mycobacterium tuberculosis in the flanks and the corneas to prepare delayed-type hypersensitivity (DTH) reactions. The animals were injected subcutaneously with lipopolysaccharide (LPS) or a synthetic lipid A (LA-15-PP). At the skin site primed with DTH reaction, increased swelling and hemorrhagic reaction followed by a definite necrotic reaction occurred. Severe corneal reactions were also observed in the animals. These findings indicate that bacterial endotoxin modulates DTH reactions and induces severe inflammatory reactions.

Comparative study of autoantigens for various bullous skin diseases by immunoblotting using different dermo-epidermal separation techniques

We investigated the reactivity of pemphigus vulgaris (PV), pemphigus vegetans, pemphigus foliaceus (Pf), Brazilian Pf, bullous pemphigoid (BP), and epidermolysis bullosa acquisita (EBA) sera with an immunoblot analysis using human epidermal and dermal extracts as a source of antigen. To obtain epidermal and dermal extracts three different dermo-epidermal separation methods were used: namely, ethylenediaminetetraacetic acid (EDTA) separation, heat separation, and dispase separation. All the 15 PV and the seven pemphigus vegetans sera demonstrated a 130-kDa PV antigen in epidermal extracts obtained by all the three methods. Furthermore, three PV sera also showed a 160-kDa Pf antigen, desmoglein. Ten of 14 Pf sera and six of 15 Brazilian Pf sera reacted with desmoglein in the same pattern in all the three epidermal extracts. Fifteen of the 22 BP sera showed reactivity with 230-kDa BP antigen in the same pattern in all the three epidermal extracts, whereas 14 BP sera detected the 180-kDa BP antigen in extracts of EDTA- and heat-separated epidermis but not in dispase-separated epidermal extract. Dermal extracts were obtained by EDTA- and heat-separated dermis, and all six EBA sera labelled a 290-kDa EBA antigen in both samples. These results suggest that heat-separated skin is as useful as EDTA-separated skin for detecting various autoantigens, but heat separation is preferable because the preparation time is shorter.

[Bullous pemphigoid simulation subacute simple prurigo]

Bullous pemphigoid (BP) is a bullous autoimmune disease of the elderly; it is characterized by tense bullae on both erythematous and otherwise apparently normal skin. Several clinical variants of BP have been described, and we now add our observations of two BP cases mimicking subacute prurigo. Both patients had suffered from intensely pruritic excoriated papules for several months before presentation. Blisters had never developed and did not occur during follow up. Histology showed changes of chronic dermatitis. In the serum of both patients, indirect immunofluorescence on NaCl-separated human skin revealed the presence of circulating antibodies binding to the roof of the artificial blisters. Perilesional skin biopsies showed linear IgG or C3-deposits in the basement membrane zone. Immunoblotting of epidermal and dermal extracts demonstrated the binding of the antibodies to an epidermal 230-kD protein, which is the known major bullous pemphigoid antigen. These cases are described as a basis for discussion of the clinical spectrum of bullous pemphigoid.