Mechanisms of eosinophil cationic protein release in the serum: role of adhesion molecules

BACKGROUND

Measurement of eosinophil cationic protein (ECP) in serum has been utilized as a marker for allergic inflammation. The serum level of ECP represents the level found in vivo plus additional proteins released in vitro from peripheral blood eosinophils during the coagulation period. The mechanisms of release, however, are unclear. We investigated a possible involvement of adhesion molecules in the ECP release.

MATERIALS AND METHODS

Venous blood was drawn in the presence of EDTA from allergic donors. The blood was incubated with neutralizing monoclonal antibodies to CD18, CD11a, CD11b, CD29, CD49d, CD54, alpha4beta7, or isotype-matched control antibodies, respectively, at 4 degrees C for 30 min. Calcium gluconate (calcium) was then added to induce coagulation. The blood was further incubated for 90 min and centrifuged to obtain the serum. ECP in the serum was measured with RIA. In some experiments, purified eosinophils were incubated with plasma and calcium, then ECP in the supernatants was assayed.

RESULTS

ECP in the samples with calcium was significantly higher than in those without calcium. Purified eosinophils released ECP upon plasma coagulation. Anti-CD18, CD49d, and alpha4beta7 antibodies significantly suppressed ECP levels in the serum.

CONCLUSIONS

These results suggest that ECP release in the serum is calcium and plasma coagulation-dependent and that cell adhesion through alphaLbeta2, alphaMbeta2, alpha4beta1 and alpha4beta7 integrins is at least in part responsible for ECP release.

Active oxygen species generation and cellular damage by additives of parenteral preparations: selenium and sulfhydryl compounds

We investigated the relationship between active oxygen species (AOS) generation and cultured vascular endothelial cellular damage caused by simultaneous exposure to selenium compounds and sulfhydryl compounds such as cysteine (Cys) or reduced glutathione (GSH). Selenium compounds, selenite, selenate or selenomethionine (SeMet), are added to total parenteral nutrition (TPN) and intravenously administered. We confirmed by luminol dependent chemiluminescence, an indicator of AOS generation, that selenite generates AOS in the presence of clinical concentrations of sulfhydryl compounds, 0.5 mM Cys or 0.5 mM GSH, and that the amount of AOS generated reaches the maximum when their mole ratio is 1:50. However, AOS generation was not observed after simultaneous administration of various concentrations of selenate or SeMet with sulfhydryl compounds. Moreover, simultaneous exposure to 10 microM selenite and sulfhydryl compounds was found to result in significant increases in the [3H]-adenine and lactate dehydrogenase (LDH) release rates from cells, a significant decrease in the amount of cellular protein, and enhancement of cellular damage as compared with after exposure to selenite alone. However, simultaneous exposure to 10 microM selenate or 10 microM SeMet together with sulfhydryl compounds did not induce cellular damage. These findings revealed that selenite generates AOS and causes cellular damage in the presence of sulfhydryl compounds. Accordingly, it seems better to choose selenate or SeMet instead of selenite when a selenium compound is to be added to TPN.

DT-diaphorase-like quinone reductase in rat plasma

The present study provides the evidence that DT-diaphorase-like quinone reductase exists in rat plasma. The quinone reductase activity toward menadione was found in rat plasma in the presence of NADH or NADPH. The enzyme activity was induced by pretreatment with 3-methylcholanthrene, but was not affected by phenobarbital. The 3-methylcholanthrene-induced quinone reductase activity was separated into three fractions (F1, F2, and F3) by gel filtration, which showed NAD(P)H-linked, NADH-linked, and NAD(P)H-linked activities, respectively. F1, which was induced by 3-methylcholanthrene, was inhibited by dicumarol, and cross-reacted with rat liver DT-diaphorase antibody.

Effects of intestinal bacteria on the development of colonic neoplasm: an experimental study

Effects of intestinal microflora on the development of colonic neoplasm induced by 1,2-dimethylhydrazine (DMH) were observed using conventionalized and gnotobiotic mouse models. The incidence of colonic adenoma in germ-free mice (IQI/jic) (GF), mice conventionalized after DMH injection (Cvz-post-DMH) and conventionalized mice (Cvz, conventionalized before DMH injection) was 74%, 69% and 58%, respectively. The mean number of adenomas per mouse in the three groups was 2.6, 2.0 and 1.4, respectively. However, the adenoma in Cvz was larger than in GF. The incidence of adenoma in mice mono-associated with Mitsuokella multiacida, Clostridium butyricum, Bifidobacterium longum, Clostridium paraputrificum, Escherichia coli and Lactobacillus acidophilus was 68%, 68%, 63%, 50%, 50% and 30%, respectively. However, the adenoma in the Cl. paraputrificum group and the Cl. butyricum group was larger than in GF. Faecal pH in Cvz and the L. acidophilus group was significantly lower than in GF. The deconjugation rate of faecal bile acids in Cvz, the Cl. paraputrificum group and the Cl. butyricum group was significantly higher than in GF. These findings suggested two different effects of microflora on the development of DMH-induced adenoma: either an inhibition of the incidence of adenoma or a promotion of tumour growth. Effects of L. acidophilus may be mediated by faecal pH and effects of Cl. paraputrificum and Cl. butyricum by deconjugated bile acids.

[Exhaled nitric oxide of childhood asthma]

Chronic airway inflammation is a central feature of pathology of bronchial asthma. In order to evaluate inflammatory status in asthma, examinations such as bronchoscope or induced sputum test can be done. Because of difficulty of those examinations we need non-invasive and simple measures for childhood asthma. Here we investigated eNO in childhood asthma. Twenty-six of atopic asthma, 13 non-asthmatic atopic children and 12 normal children were enrolled in this study. eNO was measured by chemiluminescence analyzer. eNO was significantly collerated with % FEV 1.0 and blood eosinophil counts (R = -0.494, R = 0.416, respectively). Geometrical mean of eNO in normal, non-asthmatic atopic, asthma without inhaled corticosteroid (ICS) and asthma with ICS was 16.3, 23.7, 71.6, 43.6 ppb, respectively. eNO was significantly higher in asthma than in normals. eNO in patients without ICS were significantly higher than in non-asthmatic atopic. We concluded that eNO might be useful marker for evaluation of airway inflammation in asthmatic children.

Quinone-dependent tertiary amine N-oxide reduction in rat blood

Rat blood exhibited a significant quinone-dependent N-oxide reductase activity towards imipramine N-oxide. The reduction mediated by the blood proceeded in the presence of both NAD(P)H and menadione under anaerobic conditions. When menadione was replaced with 1,4-naphthoquinone or 9,10-phenanthrenequinone, similar results were obtained. The reduction was also mediated by the combination of rat erythrocytes and plasma. The reducing activity was inhibited by dicumarol and carbon monoxide. When boiled plasma was combined with untreated erythrocytes, the N-oxide reducing activity was abolished. In contrast, when boiled erythrocytes were combined with untreated plasma, the activity was unchanged. These results suggest that the activity is caused by the heme of hemoglobin in erythrocytes and quinone reductase in plasma. In fact, erythrocytes and hemoglobin have the ability to reduce the N-oxide when supplemented with DT-diaphorase purified from rat liver in the presence of both NAD(P)H and menadione. Hemoglobin also exhibits N-oxide reductase activity with reduced menadione (menadiol). Furthermore, hematin exhibits a significant reducing activity in the presence of menadiol. The reduction appears to proceed in two steps. The first step is enzymatic reduction of quinones to dihydroquinones by quinone reductase(s) with NADPH or NADH in plasma. The second step is nonenzymatic reduction of imipramine N-oxide to imipramine by the dihydroquinones, catalyzed by the heme group of hemoglobin in erythrocytes. Cyclobenzaprine N-oxide and brucine N-oxide are similarly transformed to the corresponding amines by the above reducing system in blood. These results suggest that blood plays an important role in the reduction of tertiary amine N-oxides to tertiary amines.

Meal-related changes in plasma CCK bioactivity in patients with chronic pancreatitis

In order to clarify whether there is a negative feedback mechanism for CCK secretion, we investigated plasma CCK bioactivity in patients suffering from chronic pancreatitis (CP) according to the characteristics of their pancreatic disease. Basal, meal-stimulated, and integrated release of plasma cholecystokinin (CCK) bioactivity was measured in 24 patients with CP and in 12 healthy controls. The values obtained were compared between the healthy control group and the CP group, and between subgroups of CP patients established on the basis of the presence/absence of several parameters: abnormal gastric emptying, abdominal pain, steatorrhea, pancreatic calcification, insulin-requiring diabetes mellitus, and impairment of pancreatic exocrine functions as indicated by secretin test. A bioassay method using pancreatic acini was used to measure plasma CCK bioactivity. In the control group, plasma CCK bioactivity increased from a basal value of 1.6 +/- 0.7 pmol/L to a maximal increase of 6.6 +/- 4.1 pmol/L, and the integrated CCK release following a test meal was 37.7 +/- 19.3 pmol/L.150 min. In the CP group, plasma CCK bioactivity increased from 1.6 +/- 0.9 pmol/L to a maximal increase of 8.2 +/- 8.7 pmol/L, and the integrated release of CCK was 43.0 +/- 37.7 pmol/L.150 min. None of the differences between them were significant. No significant differences in basal value, maximal increase, or integrated plasma CCK release were noted according to any of the parameters of the CP patients and the control group. Nor was there any correlation between impairment of pancreatic exocrine function and plasma CCK bioactivity. These results provide no evidence of a negative feedback mechanism between pancreatic exocrine dysfunction and CCK secretion.

Effect of a probiotic formula on intestinal immunoglobulin A production in healthy children

The anti-infectious effect of probiotics has recently been reported and one mechanism may be the non-specific stimulation of immunity. This study was performed to elucidate the influence of a probiotic formula on intestinal microflora and local immunity in healthy children. A follow-up formula containing viable bifidobacteria was given to seven healthy Japanese children (15 to 31 months old) for 21 days. During intake of the formula, the administered strain was detected in feces from five subjects (71%) and total fecal bifidobacteria slightly increased. Fecal levels of total IgA and anti-poliovirus IgA during intake of the formula were significantly higher than those before intake (P < 0.05). The increase in local IgA levels resulting from ingestion of the probiotic formula may contribute to enhancement of the mucosal resistance against gastrointestinal infections.

[Retropharyngeal node metastasis in cancer of the oropharynx and hypopharynx: analysis of retropharyngeal node dissection regarding preoperative radiographic diagnosis]

In our department, all patients with advanced carcinoma of the oropharynx and hypopharynx are treated by retropharyngeal (RP) node dissection in addition to primary resection and standard neck dissection. Records of 42 patients (11 oropharynx, 29 hypopharynx and 2 retromandibula) who received RP node dissection from 1992 to 1996 in our department were examined for metastasis to RP nodes and for preoperative radiographic diagnosis (MRI or CT). The criteria for radiographic involvement of RP nodes are as follows: a diameter greater than 10mm on axial images or central necrosis within the nodal substance. Of the 42 patients, 6 (14.3%) had pathologically positive RP nodes and of those 6 patients, 5 were able to be diagnosed preoperatively by either CT scan or MRI. Results of radiographic diagnosis (MRI or CT) were as follows: by CT scan the sensitivity, specificity and accuracy were all 100% and by MRI the sensitivity, specificity and accuracy were 83.3%, 100% and 97.0% respectively. It is our conclusion that preoperative radiographic diagnosis (MRI or CT) is very useful and effective for diagnosis of metastasis to RP nodes.

[Theophylline reduces serum levels of ECP in vitro]

Measurement of serum levels of ECP has been widely used for monitoring airway inflammation in bronchial asthma and recently been applied to measure anti-inflammatory effect of theophylline. However, reduced levels of ECP in theophylline-administered patients may express not only in vivo effect of theophylline but also in vitro effect after sampling because serum ECP measures released ECP during coagulation and theophylline has been reported to inhibit eosinophil degranulation in vitro. In order to answer the question, we tested whether theophylline added to blood after sampling reduces measured levels of serum ECP. Various concentrations of theophylline were added to SST tube, to which venous blood from atopic patients was drawn. Serum was, then, obtained by centrifugation after 15 min to 6 hours of incubation at room temperature. Theophylline significantly reduced serum ECP in a concentration-dependent manner. Percent reduction of ECP levels at 1 hour of incubation were 11.9%, 18.7%, 22.8%, and 51.7% at theophylline levels of 5, 12.5, 22.5, and 120 micrograms/ml, respectively. Kinetics of serum ECP release was also inhibited in the presence of theophylline. These results suggest that in vitro effect of theophylline on serum ECP levels should be considered when data of serum ECP in patients who take theophylline are interpreted.

Near-infrared spectrometry analysis of fat, neutral sterols, bile acids, and short-chain fatty acids in the feces of patients with pancreatic maldigestion and malabsorption

CONCLUSION

Near-infrared spectrometry is a new, rapid, and accurate method for measuring fecal fat that does not require a great deal of chemical knowledge and that can be used by anyone. This method is considered indispensable for the diagnosis of pancreatic steatorrhea and treatment follow-up.

METHODS

Fecal fats (GLC method, van de Kamer method), neutral sterols (GLC method), bile acids (GLC method) and short-chain fatty acids (HPLC method) were assayed by the respective conventional methods in 120 subjects, including patients with pancreatic dysfunction, and the results were compared with the those obtained by near-infrared spectrometry. The correlations between fecal fat excretion measured by the GLC method (x) and van de Kamer method (x) and by near-infrared spectrometry (y) were expressed by y = 1.10x - 0.16 (r = 0.949, P < 0.01) and y = 0.750x + 1.654 (r = 0.930, p < 0.01), respectively.

RESULTS

The sensitivity and specificity of near-infrared spectrometry for fecal fats were 94.9 and 98.2%, respectively, when compared with the GLC method, and 87.5 and 90.0%, respectively, when compared with the van de Kamer method. In contrast, near-infrared spectrometry was not nearly as accurate as the conventional methods for determining neutral sterols, bile acids, and short-chain fatty acids.

Effects of high-lipase pancreatin on fecal fat, neutral sterol, bile acid, and short-chain fatty acid excretion in patients with pancreatic insufficiency resulting from chronic pancreatitis

CONCLUSIONS

Steatorrhea was almost completely stopped and malabsorption of neutral sterols and short-chain fatty acids was reduced by treatment of high-lipase pancreatin in Japanese patients with pancreatic insufficiency whose dietary fat consumption is low.

METHODS

Fifteen patients with chronic pancreatitis complicated by steatorrhea who consumed an average of 48 g of dietary fats a day were selected as subjects and given 3 g of high-lipase pancreatin (lipase, 379,800 USP U/g), at each meal (total daily dose is 9 g) for a mean duration of 28.5 d. Fecal output and fecal fat neutral sterol, bile acid, and short-chain fatty acid excretion were determined before and after the course of pancreatin therapy.

RESULTS

Pancreatin administration resulted in significant reductions (P < 0.01) in fecal output (from 243.2 to 149.1 g), excretion of fecal fat, (from 12.3 to 3.9 g), animal sterols (from 816.3 to 604.6 mg), and short-chain fatty acids (from 52.6 to 18.5 mM). In contrast, no marked changes were recorded in fecal excretion of beta-sitosterol (a plant sterol), bile acids, or the hydroxy fatty acid fraction. Fecal fat and short-chain fatty-acid excretion showed strong correlations with fecal output.

Clinical utility of serum levels of eosinophil cationic protein (ECP) for monitoring and predicting clinical course in childhood asthma

BACKGROUND

The concentration of ECP in serum has been proposed as a marker of airway inflammation in asthma. However, its clinical significance is still to be determined.

OBJECTIVES

This study was performed to determine whether concentration of ECP in serum reflects clinical status in asthma and can serve as a predictive parameter.

METHODS

Cross-sectional analysis was performed in 28 children with asthma. A total of 91 blood samples was obtained to determine levels of ECP in serum and eosinophil counts. Forced expiratory volume in 1 s was also determined at the time of the sampling. Data were analysed on the basis of asthma symptoms in the 4 weeks before and the 4 weeks after sampling.

RESULTS

Serum levels of ECP were significantly lower in patients who had been asymptomatic for 3 or 4 weeks before sampling than in patients who had been symptomatic or asymptomatic for only 1 or 2 weeks. In the former group, serum levels of ECP were higher when patients became symptomatic after sampling than when they remained stable, a finding that suggests that serum levels of ECP may have a predictive value in certain situations. Although the concentration of ECP in serum was not proved to be predictive in the latter symptomatic group, the concentration of ECP was significantly lower when measured again 4 weeks later when the patients' symptoms had resolved. In contrast, levels of ECP were unchanged when patients remained symptomatic, a finding that suggests serum levels of ECP may reflect the clinical response to therapy.

CONCLUSIONS

Serum ECP may be a useful marker for monitoring and predicting the clinical course in asthma.

Can pancreatic steatorrhea be diagnosed without chemical analysis?

CONCLUSION

Visual observation of feces, considering fecal output, is considered to be an excellent method of detection of steatorrhea when judged by experienced doctors.

METHODS

Feces from 192 patients with untreated chronic pancreatitis or under pancreatic enzyme therapy were investigated. Feces were collected for three consecutive days and homogenized with water. Fecal samples were freeze-dried and analyzed for fatty acids by gas chromatography (GLC). The quantity of fat was calculated from the amount of fatty acid to obtain daily fecal fat excretion. Comparison of GLC method with van de Kamer method gave a significant (p < 0.01) positive correlation with correlation coefficient of 0.916 (n = 38). Steatorrhea was defined as fecal fat excretion exceeding 5 g/d. Mild steatorrhea was defined as 5-10 g/d, and severe steatorrhea as more than 10 g/d.

RESULTS

Three visual identification items were used to consider fecal output exceeding 200 g/d: fecal fat concentration exceeding 4%, appearance, and odor. The results were compared with the results from GLC method. Detection of steatorrhea by means of visual properties was the most accurate, and correlation coefficient was 0.843 (p < 0.01) by Spearman's rank correlation test. This detection method was also significantly effective for differentiation of normal stool from mild and severe steatorrhea. The sensitivity and specificity were 89.3 and 91.1%, respectively, indicating a favorable result.

IL-5 as a strong secretagogue for human eosinophils

The ability of IL-5 to induce eosinophil degranulation was investigated. Peripheral blood eosinophils from patients with mildly allergic individuals were isolated with CD16- selection method. Eosinophils were then incubated with interleukin-5 (IL-5) (0.1-100 ng/ml) for 1-48 h and EPX in the supernatants were measured with RIA. We found that IL-5 induced significant amount of eosinophil protein X in a concentration-dependent manner at 24 h. Eosinophil viability was about 90% either in the presence or absence of IL-5 at 24 h. Eosinophils stimulated with IL-5 adhered to the plate. Anti-CD18 mAb blocked adhesion and degranulation induced by IL-5. Dexamethasone and TGFbeta significantly inhibited degranulation in a concentration-dependent manner. These results suggest that IL-5 may be a strong secretagogue for eosinophils, that adhesion via beta2 integrin is a requisite for degranulation, and that the anti-inflammatory effect of corticosteroids and TGFbeta may be exerted at least in part, through the inhibition of eosinophil degranulation.

Effects of epidermal growth factor on preimplantation mouse embryos

PURPOSE

Our purpose was to clarify the effects of epidermal growth factor (EGF) on mouse preimplantation embryos.

METHODS

We examined the effect of EGF on two-cell and four-cell stage mouse embryos cultured in vitro. In preimplantation embryos, we analyzed the binding of 125I-EGF by autoradiography and EGF receptor mRNA by the reverse transcription-polymerase chain reaction.

RESULTS

At more than 0.005 ng/ml, EGF relieved the two-cell block and regulated the differentiation of morula-stage embryos. These effects were negated by antiserum. EGF did not exhibit any marked effect on embryos between the four-cell and the morula stages. Specific binding for EGF and EGF receptor mRNA was detected during and after the morula stage.

CONCLUSIONS

The effects of EGF on preimplantation mouse embryos differed according to the stage of development, promoting cleavage before the four-cell stage and regulating differentiation after the morula stage. This regulatory action is thought to be transmitted to the cells via EGF receptors.

Influence of combined use of selenious acid and SH compounds in parenteral preparations

The influence of the combined use of selenious acid and SH compounds (glutathione (GSH) and cysteine (Cys), or ascorbic acid (Asc)) on cultured venous vascular cells was investigated experimentally. When cultured human umbilical venous vascular endothelial cells were exposed to 10 microM of selenious acid combined with 0.5 mM-GSH or 0.5 mM-Cys, the release rates of [3H]-adenine and lactate dehydrogenase (LDH) from cells into the medium increased significantly as compared with after exposure to selenious acid alone, and damage to the vascular endothelial cells was found to be intensified. Addition of 1 microM of selenious acid simultaneously with 0.5 mM-GSH or 0.5 mM-Cys showed no differences in toxicity for the vascular endothelial cells as compared with the addition of selenious acid alone. On the other hand, simultaneous exposure to 10 microM of selenious acid and 1 mM-Asc induced no significant differences in the release rates of [3H]-adenine and LDH, and no damage was observed to the vascular endothelial cells. These results suggest that simultaneous addition of selenious acid together with GSH or Cys, which have the SH-group, may cause damage to the vascular endothelial cells. Therefore careful attention is warranted in total parenteral nutrition (TPN).

3-dimensional computed tomography of ossification of the spinal ligament

Ossification of the posterior longitudinal ligament in the cervical spine was studied 3-dimensionally using computed tomography scans of 32 patients. The images produced were classified into 3 types based on the posterior configuration of the ossification: (1) plank shaped, (2) spindle shaped, or (3) rod shaped. Lesions with radiographically continuous and mixed type ossification on 3-dimensional computed tomography were plank shaped or spindle shaped. Rod shaped type lesions usually were radiographically segmented or showed some other type of ossification. The 3-dimensional computed tomography images change with the growth of ossification. Plank shaped type lesions appear to be the final result of ossification. Three-dimensional computed tomography scans of ossification of the longitudinal ligament are useful for decompressive surgery, providing valuable information regarding the site of concentration of compression of the spinal cord or nerve roots and the choice of surgical procedures.

Correlation between pancreatic endocrine and exocrine function and characteristics of pancreatic endocrine function in patients with diabetes mellitus owing to chronic pancreatitis

CONCLUSION

Pancreatic endocrine capacities are remarkably disturbed in patients with pancreatic diabetes owing to calcific pancreatitis as opposed to those owing to noncalcific pancreatitis. Insulin secretion in calcific pancreatitis resembled that in insulin-dependent diabetes mellitus (IDDM), whereas insulin secretion in noncalcific pancreatitis resembled that in non-IDDM (NIDDM). The involvements of acinar cell and ductal cell function closely correlate with endocrine function (insulin and glucagon secretions) in chronic pancreatitis (pancreatic diabetes).

BACKGROUND

We sought to clarify the differences of pancreatic endocrine function between pancreatic diabetes and primary diabetes, and to verify the correlations between pancreatic exocrine and endocrine dysfunction in patients with chronic pancreatitis.

METHODS

Urinary C-peptide (CPR) excretion and fasting plasma glucagon levels in patients with pancreatic diabetes owing to calcific pancreatitis (19 cases) and owing to noncalcific pancreatitis (14 cases) were studied in comparison with those in patients with insulin-dependent diabetes mellitus (IDDM, 23 cases), noninsulin-dependent diabetes (NIDDM, 18 cases), and in healthy controls (11 cases). In addition, pancreatic exocrine function was investigated in patients with chronic pancreatitis (calcific and noncalcific) and in healthy controls. The correlation between pancreatic exocrine and endocrine function was studied.

RESULTS

The urinary CPR excretion in controls was 94.9 +/- 20.5 micrograms/d. The urinary CPR excretion in calcific pancreatitis was 12.8 +/- 7.4 micrograms/d and it resembled that in IDDM (9.4 +/- 5.8 micrograms/d). The urinary CPR excretion in noncalcific pancreatitis was 41.5 +/- 30.1 micrograms/d, being similar to that in NIDDM (49.3 +/- 21.0 micrograms/d). The plasma glucagon level in calcific pancreatitis was 64.1 +/- 15.9 rho g/mL, which was significantly lower than the values in IDDM (111.2 +/- 50.2 rho g/mL) and NIDDM (96.7 +/- 21.9 rho g/mL). The plasma glucagon level in calcific and noncalcific pancreratitis (88.4 +/- 29.6 rho g/mL) were significantly lower than that in controls (129.8 +/- 21.6 rho g/mL). The residual capacities of acinar cells and ductal cells were strongly correlated with urinary CPR excretion and plasma glucagon concentration.

Study of gastric emptying in patients with pancreatic diabetes (chronic pancreatitis) using acetaminophen and isotope

The gastric emptying function tests were carried out in eight patients with pancreatic diabetes, who were classified into two groups according to the coefficient of variation in the R-R interval in ECG (C.V. R-R) on the normal subjects: < or = the mean - 2SD (the autonomic nerve dysfunction group: AND+ group) and > the mean - 2SD (the autonomic nerve normal group: AND- group). Both the gastric emptying of liquid food by the acetaminophen method and that of solid food by the isotope method were significantly reduced in the AND+ group than in the AND- and normal groups. In addition, a significant correlation was found between the C.V. R-R and the serum acetaminophen concentration (a 45 min value) and the % gastric retention of isotope (a 120 min value). The above results demonstrated that even pancreatic diabetes might be complicated by gastroparesis diabeticorum among autonomic nerve dysfunction. There was a close relation of delayed gastric emptying to the C.V. R-R in ECG or an index of the vagus nerve function.

Factors influencing the development of sigmoid colon cancer. Bacteriologic and biochemical studies

BACKGROUND

Cancer of the sigmoid colon is especially sensitive to environmental factors such as food. The authors have conducted a series of studies with food as the external environmental factor and intestinal microflora as the internal environment factor in relation to sigmoid colon carcinogenesis.

METHODS

Thirteen males who had previously undergone surgery for sigmoid colon cancer, and who later developed new epithelial neoplasia of the colon, were chosen as the high risk (HR) group. Fourteen males of similar age, whose large bowel was entirely normal by total colonoscopy, were chosen as the control (CONT) group. Food constituents were analyzed by a dietician. Fecal bile acids, cholesterol metabolites, degradation products of amino acids, pH, water content, and bacterial flora were quantitatively analyzed.

RESULTS

Although the HR group consumed slightly more carbon hydrate, fiber, and calcium, as a whole, there was no significant difference in food constituents, especially animal fat, between the two groups. Concentrations of bile acids and cholesterol metabolites were not different between the groups, with the exception of a higher level of cholestanol in the HR group. Succinic, lactic, propionic, and isovaleric acids were abundant in the HR group. Fecal pH and amounts of hydrogen sulfide and cresol also were higher in the HR group. The total amount of bacteria, lecithinase-negative Clostridia, and Lactobacillus, were also more abundant in the HR group.

CONCLUSIONS

The feces of the HR group was abundant in such substances as sigmoid colon cancer promoters, and appeared unrelated to food constituents. Resident flora of the HR group were abundant in enzymatically active anaerobes. Because agents carcinogenic to the colon and rectum exist ubiquitously, microflora play a key role in sigmoid colon carcinogens by producing promoters.

Selenium administration to a ten-year-old patient receiving long-term total parenteral nutrition (TPN)--changes in selenium concentration in the blood and hair

Muscle pain in the lower limbs occurred in a child with short bowel syndrome who has been receiving longterm total parenteral nutrition (TPN). Biochemical parameters revealed that the plasma and erythrocyte selenium concentrations were below the normal range for children and intravenous injection of selenium prepared from selenious acid was started at a dose of 100 micrograms per day. Muscle pain in the lower limbs disappeared one month afterwards. At this point in time, the elevation of the plasma selenium concentration was noted but the erythrocyte selenium concentration remained low. When administration was suspended due to catheter-induced fever five months later, the whole blood selenium concentration decreased again and the symptoms recurred. Accordingly, the dose of selenium was increased to 200 micrograms/day. Subsequently, the blood selenium concentration recovered to the normal range for children. After the dose increase to 200 micrograms/day, concentrations in hair samples collected at every centimeter distance from the root end were determined. The selenium concentration at the root end was found to be higher than the normal range for children, indicating that this was an excessive dose case. Although the dose was decreased from 200 micrograms/day to 120 micrograms/day, the plasma and erythrocyte selenium levels did not go down. Furthermore, the selenium level in the hair reached a plateau, and no recurrence of symptoms was observed. The above results indicate the usefulness of monitoring the selenium concentration in hair in addition to determining the blood selenium level and GSH-Px activity in administering selenium to children undergoing TPN.

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.

Stereospecific taurine conjugation of the trans-OH metabolite (active metabolite) of CS-670, a new 2-arylpropionic acid nonsteroidal anti-inflammatory drug, in dogs

CS-670, (+/-)-2-[4-(2-oxocyclohexylidenemethyl)phenyl]propionic acid, is a novel derivative of 2-arylpropionic acid non-steroidal anti-inflammatory drugs (profen NSAIDs). The major urinary metabolite of this drug from dogs was isolated and its chemical structure was determined by MS and NMR spectroscopy. The metabolite was identified as a taurine conjugate of the trans-OH form (trans-OH-taurine) which was first generated by stereoselective reduction of the double bond and the carbonyl function of the CS-670 molecule. The taurine conjugate was excreted in urine as the main metabolite, regardless of the optical configuration of CS-670 administered [2R)-enantiomer: 47.2% of the dose, (2S)-enantiomer: 70.9% of the dose]. The trans-OH-taurine was hydrolyzed by refluxing it in 6 N HCl without racemization. The released trans-OH was derivatized to diastereoamides with (+)-(R)-1-(1-naphthyl)ethylamine to examine the stereochemical properties of the 2-arylpropionic acid side chain. It was found that the configuration of the 2-carbon of the trans-OH-taurine was almost entirely (S). As the CoA thioesters are obligate intermediates for amino acid conjugation, the results suggest that the (2S)-enantiomer of the trans-OH metabolite serves as a substrate for canine acyl CoA ligase (EC 6.2.1.3) as well as the (2R)-enantiomer, but only the CoA thioester with a (2S)-configuration is a substrate for taurine N-acyl transferase. It is interesting to note that these results are not consistent with the chiral inversion mechanism by which the (2R)-enantiomers of profen NSAIDs are stereospecifically converted to CoA thioester intermediates.

Effect of omeprazole on changes in gastric and upper small intestine pH levels in patients with chronic pancreatitis

Gastric and upper small intestine pH levels were measured continuously over 24 hours in patients with chronic pancreatitis, and values obtained before and after the administration of omeprazole were compared. Additionally, omeprazole was administered for 2 weeks and the fecal excretion of fat was compared before and after drug therapy. Postprandial gastric pH levels, initially 2.9 to 3.2, increased by 1.6 to 2.1 after treatment. Postprandial upper small intestine pH levels, initially 5.1 to 5.5, increased by 0.7 to 1.0. The lowest pH value of the upper small intestine was 2.2 to 2.4 postprandially; this was increased by > 1.0 after omeprazole, and the amplitude of pH variation was reduced. The cumulative proportions of intraintestinal pH strata of < or = 3, < or = 4, or < or = 5, and higher, initially being 16.4% to 17.1%, 27.4% to 31.7%, and 52.6% to 57.8%, respectively, were remarkably improved after drug treatment. Gastric pH and upper small intestine pH levels showed a positive correlation; an increase in gastric pH levels by 2 corresponded to an increase in small intestine pH levels by 1. After omeprazole administration, mean fecal excretion of fat was decreased to 4.1 +/- 2.6 g/d (range, 1.1 to 9.8 g/d) from 6.5 +/- 3.9 g/d (range, 1.6 to 13.5 g/d). Decreases in excretion of fat averaged 3.4 g/d (range, 2.2 to 4.5 g/d) in patients with steatorrhea. It was concluded that steatorrhea due to chronic pancreatitis can be improved to some extent by improving upper small intestine pH levels following the elevation of gastric pH levels after administration of omeprazole.