Expression of gelatinase A, tissue inhibitor of metalloproteinases-2, matrilysin, and trypsin(ogen) in lung neoplasms: an immunohistochemical study

Lung cancer is a heterogeneous tumor in terms of clinical and biological behavior, and its aggressiveness depends on its invasive and metastatic properties. Matrix metalloproteinases and serine proteinases are believed to play a crucial role in invasion and metastasis of malignant tumor cells. In the present study, the authors evaluated immunohistochemically the expression of gelatinase A; tissue inhibitor of metalloproteinases-2 (TIMP-2), an inhibitor of gelatinase A; matrilysin; and trypsin(ogen) in 67 lung tumors from a variety of histological types including 17 squamous cell carcinomas, 16 adenocarcinomas, 15 small cell carcinomas, and 12 carcinoids. Interestingly, normal bronchial, bronchiolar, and alveolar epithelial cells expressed gelatinase A, TIMP-2, matrilysin, and trypsin(ogen) at varying frequencies and intensities. Bronchial smooth muscle cells and cartilage cells expressed gelatinase A alone, whereas endothelial cells, fibroblasts, and macrophages expressed gelatinase A and TIMP-2. Gelatinase A was expressed at high levels in most lung tumors examined (47% to 80%). TIMP-2 was also expressed at high levels except in the small cell carcinomas, which showed TIMP-2 expression at a lower frequency (60%) compared with other types of lung tumors (80% to 100%). Although matrilysin was expressed by tumor cells of all the histological types at various frequencies (13% to 63%), its expression was most common in adenocarcinomas. Expression of trypsin(ogen) was observed almost exclusively in adenocarcinomas (56%); other types of lung tumors expressed trypsin(ogen) far less frequently (0% to 12%). The present results, taken together with those of previous studies, suggest that gelatinase A is associated with malignant behavior of all the types of lung tumors, whereas its activity may be controlled by the endogenous inhibitor TIMP-2. The aggressive clinical behavior of small cell carcinoma may be attributable, at least in part, to a loss of the inhibitory effect of TIMP-2, as a significant proportion of these tumors showed negative or low levels of TIMP-2 expression. Matrilysin and trypsin(ogen) expressions are unlikely to be correlated with the aggressiveness of lung tumors. The expression of trypsin (ogen) may rather reflect the differentiation of adenocarcinoma cells toward normal airway epithelial cells.

Early administration of Bifidobacterium breve to preterm infants: randomised controlled trial

AIM

To investigate the colonisation with Bifidobacterium breve of the bowels of very low birthweight (VLBW) infants.

METHODS

The adverse effects of B breve were examined in 66 VLBW infants (preliminary study). A prospective randomised clinical study of 91 VLBW infants was also completed and these infants were followed up for three years. Precise viable bacterial counts of serial stool specimens were examined for the first eight weeks after birth in 10 infants. The colonisation rates of administered bacteria were examined using immunohistochemical staining of stool specimens with a B breve specific monoclonal antibody.

RESULTS

In the preliminary study there were no side effects attributable to the bacteria. Immunohistochemical staining of stool specimens showed that the colonisation rates of the administered bacteria were 73% at 2 weeks of age, but only 12% in the control group. Early administration of B breve significantly decreased aspirated air volume from the stomach and improved weight gain.

CONCLUSIONS

B breve can colonise the immature bowel very effectively and is associated with fewer abnormal abdominal signs and better weight gain in VLBW infants, probably as a result of stabilisation of their intestinal flora and accelerated feeding schedules.

[A boy highly suspected of hypersensitivity pneumonitis characterized by generalized mucosal lesions]

The case is a boy who developed progressive dyspnea and had since been followed over a long period time as a case of unknown fever without respiratory symptoms. He showed mucosal symptoms such as intraoral aphtha, eosinophilic pyuria and diarrhea and was clinically diagnosed as hypersensitivity pneumonitis. The affected child showed high levels of circulating immune complex, a decline in DLco on the respiratory function test and a decrease in CD 4/8 in bronchoalveolar lavage lymphocytes; furthermore, an antibody specific to Aureobasidium pullulans was positive in the precipitated antibody test. As for the immune function of the affected child during the follow-up, hypergammaglobulinemia and various immune abnormalities were observed. We thought the clinical feature of the affected child to be of pathophysiological value in dealing with unknown fever in childhood, so we reported our findings in this paper.

[Seven cases of hemophagocytic syndrome complicated with childhood collagen diseases]

We encountered seven children with hemophagocytic syndrome complicated with collagen diseases of whom five were JRA and two SLE, HPS was seen as one of initial symptoms in 6 cases excluding one case of JRA. Hematologically, cytopenia in 2 cell lines (RBC and platelets) was seen in most cases. Active hemophagocytosis by matured large histiocytes was observed in all cases. All patients had moderately to extremely high serum ferritin levels and LDH levels. Although both lives did not correlated with prognosis in HPS with collagen disease, the higher serum total cholesterol/serum triglyceride ratio, the worse was the prognosis. Those findings suggested that HPS in collagen diseases may be a different entity from other types of HPS.

[A 12-year-old girl with acute respiratory disease with pneumonia caused by adenovirus type 7]

We have encountered a 12-year-old girl with acute respiratory disease including pneumonia caused by adenovirus type 7. While being followed-up for bronchial asthma, she developed this disease with dyspnea accompanied by high fever, pharyngalgia and a dry cough subsequent to a slight fever. Adenovirus type 7 was separated and identified from the pharyngeal smear. Additionally, perfusion scintigraphy of the lungs presented evidence of interstitial pneumonia. with these findings and the clinical course put together, this case was diagnosed as having acute respiratory disease with pneumonia caused by adenovirus type 7. Thereafter, perfusion scintigraphy of the lungs continued showing interstitial shadows, which suggested the presence of severe sequlae of the lung. Formerly the separation rate of adenovirus type 7 was low in Japan, but the rate has tended to increase in cities in recent years. Cases presenting such acute, severe respiratory symptoms are expected to increase in the future, and clinically we consider to be our case important enough to be reported.

Effect of chorioamnionitis on the levels of serum proteins in the cord blood of premature infants

OBJECTIVE

To determine the relationships among complements, other serum proteins (including acute-phase reactant), and the cytokine interleukin-6.

DESIGN

Prospective observational study.

SETTING

A perinatal center, children's hospital, and research institute in Osaka, Japan.

PATIENTS

Two hundred fifteen newborn infants ranging from 17 to 42 weeks in gestational age.

MAIN OUTCOME MEASURES

We measured the serum levels of several proteins and complements in the cord blood of neonates with and without chorioamnionitis by immunological assays.

RESULTS

The levels of C3d, haptoglobin, interleukin-6, IgM, C-reactive protein, and IgA were not influenced by gestational age, and levels of C5, C1q, C2, albumin, C9, and IgG were not influenced by chorioamnionitis status. The levels of C3, C4, CH50, factor B, and orosomucoid were influenced by both factors.

CONCLUSIONS

Our investigation of the mutual relation of the data suggests that the increase of cytokine interleukin-6 affects each other component. We suggest that, compared with the serum levels of proteins in neonates with chorioamnionitis, levels in neonates without chorioamnionitis are more similar to those in the normal fetus.

[TIMPs (tissue inhibitors of metalloproteinases): their species, functions and effects on tumor metastasis]

TIMPs (tissue inhibitors of metalloproteinases) belong to a family composed of three members: TIMP-1, -2 and -3. They possess a high degree similarity in their structure including 12 conserved cystenyl residues at the same relative positions. Recently, they have been shown to inhibit not only proteolytic activities of metalloproteinases but also tumor cells metastasis in vitro and in vivo. In this review, we summarize their structure information, inhibitory mechanism of metalloproteinases, TIMPs-like secretory inhibitors, other biological functions of TIMPs such as growth-regulating activity, their chromosomal localizations and related diseases. We also mention their inhibitory effects on tumor cells metastasis in vitro and in vivo, and their clinical applications.

A patient with Schinzel-Giedion syndrome and a review of 20 patients

The Schinzel-Giedion syndrome is characterized by severe midface retraction, multiple skull anomalies, clubfeet, and cardiac and renal malformations. So far, 20 patients have been reported. This is the first report of the syndrome demonstrated in Oriental patients. In surviving patients, severe growth and developmental deficiency is a common finding.

[Chronic cytomegalovirus infection that present specific clinical course--a case of a boy with common variable immunodeficiency]

We describe an 8-year-old boy with CVID and chronic CMV infection. Although at onset he was diagnosed as IgA deficiency, 4 years after his clinical manifestations because compatible to CVID. During his clinical course he had suffered from various disorders as follows; AIHA, interstitial pneumonia, hemophagocytic syndrome, chronic gastroenterocolitis and so forth. At the age of 8 the PCR of CMV-DNA of biopsy specimen from colon, lung and bone marrow were confirmed to be positive. Hematological examinations revealed abnormal cellular immunity such as decreased CD 4/8 ratio with increased HLA- DR+ CD 8+ T cell, decrease of absolute blood lymphocytes count and reduced response of lymphocytes to blastogenetic agents. These findings brought us to diagnose him as having CVID complicated with chronic CMV infection. This case gives us some impact to speculate what role CMV infection plays in CVID, Whose etiology is unknown.

[Effective combination therapy by recombinant erythropoietin and cepharanthin in a girl with refractory anemia]

A 3-year-old girl was admitted with a one-month history of a tendency to bleed to Jikei Kashiwa hospital in May, 1992. She developed pancytopenia as follows; hemoglobin: 8.6 g/dl, red blood cell: 316 x 10(4)/microliters, reticulocyte: 9,480/microliters, white blood cell: 2,500/microliters (neutrophil: 400/microliters) and platelet count: 2.7 x 10(4)/microliters. Her bone marrow was hypoplastic, but was so dysplastic in 3 cell-lines as to be diagnosed as hypoplastic refractory anemia. After two courses of methylprednisolone pulse therapy followed by oral prednisolone therapy which were not effective and were supplemented by blood transfusions, the treatment of 20mg/day oral Cepharanthin, a biscoclaurine alkaloid, and intravenous recombinant human erythropoietin (rhEPO) twice a week at dose of 6,000 U/week was initiated in January, 1993. About 3 months later she showed a steady rise in hemoglobin concentration (from 4.1 to 11.9 g/dl) and platelet count (from 4,000 to 39,000/microliters). Although the rhEPO was tapered and ceased in September, 1993, her hemoglobin concentration has ranged from 11.0 to 11.9 g/dl and her platelet count from 30,000 to 40,000/microliters by giving her Cepharanthin and low dose prednisolone.

[A case of pure red cell aplasia associated with sodium valproate therapy]

We reported a 14-year-old female with petit mal epilepsy who suffered from pure red cell aplasia 12 weeks after sodium valproate (VPA) therapy started. On admission she presented anemia but no jaundice. Her hemoglobin was 5.4g/dl and bone-marrow biopsy revealed hypocellularity with erythroid hypoplasia. The Direct Coombs' test and anti-nucleotide antibody were positive. Reticulocytosis occurred 10 days after discontinuation of VPA. The Direct Coombs' test became negative one year after discontinuation of VPA. In general, drug-induced PRCA is caused by toxic or allergic agents, but this case suggests the immune mechanism of VPA-induced PRCA.

Ultrastructural localization of myeloperoxidase activity in acute monoblastic leukemia

In five patients with acute monoblastic leukemia (AMoL), the ultrastructural localization of myeloperoxidase (MPO) activity was investigated by two methods, one generally used for the detection of MPO and the other for the detection of platelet peroxidase. The MPO-positive rate achieved was lower with the former method than with the later, indicating that MPO is degraded during the fixation of AMoL cells for electron microscopy. If the ultrastructural MPO positivity of leukemic cells varies when different detection methods are used, the possibility of monocytic leukemia should be considered.

Increased leukocyte elastase of the tracheal aspirate at birth and neonatal pulmonary emphysema

OBJECTIVE

The authors have previously shown the association of elevated neonatal serum IgM and chorioamnionitis in infants in whom pulmonary emphysema characteristic of Wilson-Mikity syndrome subsequently developed. This paper extends the observation to the measurement of polymorphonuclear leukocyte elastase-alpha 1-proteinase inhibitor complex (PMN elastase-alpha 1-PI) in tracheal aspirates of infants with chronic lung disease.

PATIENTS

Tracheal aspirates were obtained from 90 very low birth weight neonates within 24 hours of birth. Serum also was collected within 72 hours of birth, and placentas were examined for signs of inflammation.

RESULTS

The mean PMN elastase-alpha 1-PI was significantly elevated (21.8 micrograms/mg albumin) in infants with a pulmonary emphysema syndrome like that designated by Wilson-Mikity compared either with those with bronchopulmonary dysplasia (1.5 micrograms/mg albumin, P < .01) or those with respiratory distress syndrome in whom bronchopulmonary dysplasia did not develop (2.3 micrograms/mg albumin, P < .01). Infants with pulmonary emphysema had a significantly elevated mean serum IgM and a high incidence of chorioamnionitis.

CONCLUSIONS

The level of PMN elastase-alpha 1-PI was increased in the tracheal aspirates of newborns in whom pulmonary emphysema developed. Intrauterine inflammation may increase the level of PMN elastase in the fetal respiratory tract. This increase in PMN elastase-alpha 1-PI in fetal lung tissue may cause lung injury in utero, resulting in postnatal pulmonary emphysema consistent with the Wilson-Mikity syndrome following ventilation.

Relationships of lipid and glucose metabolism with waist-hip ratio and physical fitness in obese men

The waist-hip ratio (WHR) is an indirect index of abdominal type obesity which has been shown to be strongly correlated with the risk of coronary heart disease. Empirically, men who have a higher WHR seem to have a lower level of physical fitness. In the present study, the relationships of lipid and glucose metabolism with WHR and physical fitness were examined in 207 Japanese obese men. Physical fitness was evaluated by the oxygen uptake at the onset of blood lactate accumulation (OBLA-VO2; ml/kg/min) which corresponds to 4 mmol/l of blood lactate during graded exercise test and is one of the best indicators of the muscle oxidative capacity. The WHR and percentage of body fat (% body fat) were significantly correlated with OBLA-VO2. The WHR and % body fat were significantly related to each other. After adjusting for % body fat, a significant negative correlation was observed between the WHR and OBLA-VO2 (r = -0.24; P < 0.05). A multiple linear regression was calculated for parameters relating to lipids, and glucose and insulin areas separately, when the WHR, OBLA-VO2, % body fat and age were entered as independent variables. OBLA-VO2 significantly showed a negative relationship with triglyceride (TG), HDL-C/total cholesterol, and the insulin area, while the WHR was only independently related to TG. From these results, we conclude that the physical fitness level evaluated by OBLA-VO2, which represents the capacity of the aerobic metabolism in muscle, may thus be a determinant of lipid and glucose metabolism in obese men.

Fetal mononuclear cells show a comparable capacity with maternal mononuclear cells to produce IL-8 in response to lipopolysaccharide in chorioamnionitis

IL-8 is a chemotactic and activating cytokine for neutrophils which eliminate invading bacteria by releasing bactericidal metabolites. Cord blood mononuclear cells (CBMCs) obtained from neonates born to mothers with chorioamnionitis actively produced a significantly higher amount of IL-8 than those of neonates without chorioamnionitis, suggesting that the mononuclear cells of fetuses with chorioamnionitis had been activated in utero. As lipopolysaccharide (LPS) can often be detected in the uteroplacental space in chorioamnionitis, the LPS-mediated activation mechanism of neonatal mononuclear cells was analyzed in vitro to produce IL-8. Neonatal mononuclear cells stimulated with LPS increased IL-8 production in a time- and dose-dependent manner. The ability of term or preterm neonatal mononuclear cells to produce IL-8 was comparable with that of adult (maternal) mononuclear cells, suggesting functional maturity of the neonatal or fetal mononuclear cells to produce IL-8. However, IL-8 production by neonatal CBMCs was down-regulated by dexamethasone, a glucocorticoid which is clinically administered to mothers to promote fetal lung maturity in preterm delivery. Our present study revealed a regulatory mechanism of fetal IL-8 production, suggesting that functionally mature fetal mononuclear cells produce IL-8 in response to LPS in chorioamnionitis and activate the fetal defense mechanism against infection.

[The measurement of erythrocyte zinc protoporphyrin/heme ratio in various anemias in childhood]

The measurement of erythrocyte zinc protoporphyrin (ZPP) with a hematofluorometer is known to be a simple and cost-effective method to screen iron deficiency and lead poisoning. We measured ZPP on blood samples from 201 children suffering from various diseases, which revealed that ZPP has better sensitivity and specificity for identifying iron deficiency than serum ferritin and percent transferrin saturation. ZPP levels in various anemias were also measured. ZPP rose markedly (> 200 mumol/mol heme) in untreated iron deficiency anemia and returned to normal in 3-4 months since the initiation of iron therapy. Moderate elevation of ZPP was observed in acute leukemia (at onset and during induction therapy), MDS, aplastic anemia and some other anemic conditions. These findings suggest that erythrocyte ferrochelatase may be unexpectedly affected in anemias even except lead poisoning.

BUN/Cr ratio as an index of gastrointestinal bleeding mass in children

Determining the site and severity of blood loss is important in the management of children with gastrointestinal (GI) bleeding. Blood urea nitrogen (BUN) and serum creatinine (Cr) were measured on the day of hospitalization and the ratio of BUN/Cr was calculated in 11 children with 16 episodes of upper GI bleeding and 49 with lower GI bleeding. There was a significant difference between the two GI bleeding groups with regard to BUN/Cr ratio (p less than 0.001). When the ratio was 30 or above, the specificity of upper GI bleeding was 98% with a sensitivity of 68.8%. A linear relationship was found between the BUN/Cr ratio and delta Hb (delta Hb = 0.08 x BUN/Cr +/- 0.8 g/dl) for bleeding originating from the upper GI tract. This study confirms that measurement of the BUN/Cr ratio is useful for localizing the source of bleeding to the upper GI tract and also demonstrates its usefulness as an estimation of the severity of blood loss from the upper GI tract.

Significance of chorioamnionitis

In preterm deliveries, we have reported a high incidence (30-50%) of histologic chorioamnionitis (CAM) in the placenta. There is little evidence about the effects of CAM on preterm infants. We investigated the levels of complements and cytokines in the cord blood, the pathological nature of the placenta, the L/S ratio of gastric and tracheal aspirate of each preterm infant at birth, and assessed the biological effects of CAM on them. CAM stimulates the immunological system by cytokine production (IL6 and IL8) and complement activation in the fetus. It has been suggested that CAM may be one of the factor accelerating fetal maturation of the immunological system such as complement activation and immunoglobulin production, and of surfactant synthesis in the lung. On the contrary, CAM may damage the structures along the lining cells in the airway by accumulating polymorphonuclear cells of the infants with Wilson-Mikity syndrome.

Interleukin-8 in cord sera: a sensitive and specific marker for the detection of preterm chorioamnionitis

Interleukin-8 (IL-8) exerts chemotactic activity on neutrophils at inflammatory sites to eliminate invading bacteria. To investigate whether the preterm fetus with chorioamnionitis produces IL-8, the titers of IL-8 were examined in sera of babies with (n = 38) and without chorioamnionitis (n = 34) using an EIA kit specific for IL-8. The infected babies had a significantly higher IL-8 titer than those not infected at 22-36 gestational weeks. The IL-8 titer was increased even in the mild histologic stage of chorioamnionitis and became much higher in the more severe stage. The IL-8 elevation, however, was remarkably suppressed by infusion of a steroid into the mother to promote fetal lung maturation. This retrospective study demonstrated that titration of IL-8 in cord serum is a more useful marker for the early detection of chorioamnionitis, because of its higher sensitivity and specificity, than conventional markers such as C-reactive protein.

Acute myelomonocytic leukemia with marrow eosinophilia showing 5q- and 16q22 mosaicism

We report an 82-year-old Japanese female with acute myelomonocytic leukemia with dysplastic marrow eosinophilia (FAB M4Eo) exhibiting a partial deletion of the long arm of chromosome 5, del(5)(q13q31) and a derivative chromosome 16 with a breakpoint at band 16q22, in addition to 5q-. The patient had a history of a preleukemic phase for several months with marked dysplasia in trilineage marrow cells, in addition to leukemic features compatible with M4Eo. These findings strongly suggested that the leukemic cells in this case were derived from a preleukemic clone with a del(5q).

[Primary myelofibrosis transforming into multiple subcutaneous monoblastoma--a case report]

A 83-year-old man was diagnosed with primary myelofibrosis based on the presence of leukoerythroblastosis, splenomegaly, chromosome 46 XY, a dry tap bone marrow aspiration and fibrosis on bone marrow biopsy, when he was admitted for herpes zoster in June 1987. He was admitted for a second time with multiple subcutaneous tumors over his entire body in July, 1989. He had mild splenomegaly, but no hepatomegaly nor lymphadenopathy. Laboratory tests were as follows: RBC 214 x 10(4)/microliters, Hb 5.1 g/dl, Ht 17.7%, WBC 3,200/microliters with leukoerythroblastosis, platelets 11.6 x 10(4)/microliters, s-lysozyme 251 micrograms/ml, u-lysozyme 770 micrograms/ml, NAP ratio 98%, score 278. Bone marrow aspiration resulted in a dry tap. Bone marrow biopsy showed marked fibrosis. Histologic examination of subcutaneous tumor biopsy specimens revealed a diffuse infiltration of monocytes with flexuous nuclei. These cells were positive for alpha-naphtyl butyrate esterase stain, and negative for peroxidase, alpha-naphtol ASD chloroacetate esterase stain and platelet glycoprotein IIb/IIIa stain (APAAP). Ultrastructurally, these cells were mostly monocytes and promonocytes, while phenotypically, CD11b, CD13, CD14, CD33 and HLA-DR were positive. These date indicated that the subcutaneous tumors originated from monocytes.

[Extremely low birth-weight infant with hydrocephalus; management of hydrocephalus using a miniature Ommaya's reservoir]

Use of the miniature Ommaya's reservoir in the treatment of extremely low birth-infant (under 1,000 mg) with hydrocephalus was studied in a series of five patients. The reservoir has a small-caliber with a 3 cm ventricular catheter. For these infants, this miniature Ommaya's reservoir is extremely useful for protection of the cortical mantle until a definitive procedure can be carried out after increase of body weight. The clinical course in five cases are summarized.