Extremely high serum level of IgE during immunosuppressive therapy: paradoxical effect of cyclosporine A and tacrolimus

A case of X-linked autoimmune enteropathy was successfully treated with cyclosporine A (CsA) or tacrolimus (FK506) and developed extremely high serum levels of IgE during the immunosuppressive therapy. Serum IgE levels increased from 190 to 1,000-2,500 IU/ml with CsA therapy and as high as 80,000 IU/ml with subsequent FK506 therapy. Serum IgG2 and IgG4 levels were slightly elevated compared to serum IgE levels. Thereafter, serum IgE levels progressively decreased in parallel with a reduced dosage of FK506. Total serum IgG levels and peripheral eosinophil counts, however, showed no significant changes during the course. These observations suggest that both CsA and FK506, potent immunosuppressants, could paradoxically enhance some immune responses, possibly through the action of CsA-/FK506-resistant immune systems.

[A case of ventricular septal perforation treated surgically with an infarction exclusion technique]

We report an 85-year-old woman with postinfarction interventricular septal perforation. She underwent successful emergent surgical treatment by a slightly modified method based on David-Komeda's procedure. Perforation in this case occurred four days after acute myocardial infarction. Preoperative Qp/Qs was 2.58, and pulmonary artery pressure was 34/25 mmHg. The area of infarction was large, and the perforation was the linear type 2.5 cm long near the apex. A probe was not able to pass through the perforation due to its complicated configuration. A double Xenomedica patch was sutured on the left side of the interventricular septum without excising the infarcted area. The suture line was placed on healthy myocardium apart from the infarcted area. The Xenomedica patch was sandwiched between the closure line of the ventriculotomy. Four days after surgery, residual shunt was observed by echocardiogram, but this subsequently disappeared on the 17th postoperative day. The patient was discharged from our hospital on the 57th postoperative day, and is now doing quite well.

Mutations in the hepatocyte nuclear factor-4alpha gene in maturity-onset diabetes of the young (MODY1)

The disease maturity-onset diabetes of the young (MODY) is a genetically heterogeneous monogenic form of non-insulin-dependent (type 2) diabetes mellitus (NIDDM), characterized by early onset, usually before 25 years of age and often in adolescence or childhood, and by autosomal dominant inheritance. It has been estimated that 2-5% of patients with NIDDM may have this form of diabetes mellitus. Clinical studies have shown that prediabetic MODY subjects have normal insulin sensitivity but suffer from a defect in glucose-stimulated insulin secretion, suggesting that pancreatic beta-cell dysfunction rather than insulin resistance is the primary defect in this disorder. Linkage studies have localized the genes that are mutated in MODY on human chromosomes 20 (MODY1), 7 (MODY2) and 12 (MODY3), with MODY2 and MODY3 being allelic with the genes encoding glucokinase, a key regulator of insulin secretion, and hepatocyte nuclear factor-1alpha (HNF-1alpha), a transcription factor involved in tissue-specific regulation of liver genes but also expressed in pancreatic islets, insulinoma cells and other tissues. Here we show that MODY1 is the gene encoding HNF-4alpha (gene symbol, TCF14), a member of the steroid/thyroid hormone receptor superfamily and an upstream regulator of HNF-1alpha expression.

Mutations in the hepatocyte nuclear factor-1alpha gene in maturity-onset diabetes of the young (MODY3)

The disease non-insulin-dependent (type 2) diabetes mellitus (NIDDM) is characterized by abnormally high blood glucose resulting from a relative deficiency of insulin. It affects about 2% of the world's population and treatment of diabetes and its complications are an increasing health-care burden. Genetic factors are important in the aetiology of NIDDM, and linkage studies are starting to localize some of the genes that influence the development of this disorder. Maturity-onset diabetes of the young (MODY), a single-gene disorder responsible for 2-5% of NIDDM, is characterized by autosomal dominant inheritance and an age of onset of 25 years or younger. MODY genes have been localized to chromosomes 7, 12 and 20 (refs 5, 7, 8) and clinical studies indicate that mutations in these genes are associated with abnormal patterns of glucose-stimulated insulin secretion. The gene on chromosome 7 (MODY2) encodes the glycolytic enzyme glucokinases which plays a key role in generating the metabolic signal for insulin secretion and in integrating hepatic glucose uptake. Here we show that subjects with the MODY3-form of NIDDM have mutations in the gene encoding hepatocyte nuclear factor-1alpha (HNF-1alpha, which is encoded by the gene TCF1). HNF-1alpha is a transcription factor that helps in the tissue-specific regulation of the expression of several liver genes and also functions as a weak transactivator of the rat insulin-I gene.

Complications of childhood Sjögren syndrome

Sjögren syndrome (SS) is a common disorder in adults and involves both glandular and extraglandular systems. We report here four cases of childhood SS complicated by chronic thyroiditis, interstitial nephritis or sweat gland inflammation. Additionally, in one of these cases, the central nervous system was involved. All of these complications are common in adult cases.

CONCLUSION

Childhood SS is a systemic "ductilitis" or "exocrinopathy" with complications which are commonly observed in adult cases.

Sequence of human hexokinase III cDNA and assignment of the human hexokinase III gene (HK3) to chromosome band 5q35.2 by fluorescence in situ hybridization

Complementary DNA clones encoding human hexokinase III were isolated from a liver cDNA library. There was 84.7% identity between the amino acid sequences of human and rat hexokinase III. RNA blotting showed the presence of hexokinase III mRNA in liver and lung. Fluorescence in situ hybridization localized the human hexokinase III gene (HK3) to chromosome 5, band q35.2.

Identification of a novel myosin heavy chain gene expressed in the rat larynx

Based on reactivity to antibodies against known myosin heavy chains, expression of a novel fast myosin heavy chain (MHC) gene was suspected in the thyroarytenoid (TA) muscle of the rat larynx. The 3' ends of MHC transcripts in the TA were amplified by RT-PCR using a primer to a highly conserved MHC sequence and to the poly(A) tail. The resultant products were cloned and fourteen PCR products were screened by dot-blotting with oligonucleotides specific for known skeletal muscle MHC genes. A clone that reacted weakly to the 2B oligo was sequenced and found to encode a novel fast MHC transcript, termed 2L, that appears to represent an eighth vertebrate skeletal muscle MHC gene. By homology analysis, the 2L sequence is most similar to the extraocular MHC, suggesting a possible evolutionary relationship between MHCs associated with the branchial arches.

[Coronary artery bypass grafting for acute myocardial infarction]

Five hundred and fourteen cases with acute myocardial infarction were admitted to our hospital during the past 5 years, since April 1990. Among 343 cases who had emergency coronary angiography, 53 cases had coronary artery bypass grafting surgery within 2 weeks after the onset of acute myocardial infarction. Mean number of bypass grafts was 2.9 +/- 0.9/patient, and operative mortality was 25% (13/53). Clinical condition immediately before the surgery and surgical mortality was, shock state in 20 cases (mortality 50%), IABP dependent state in 23 cases (mortality 13%), post-infarction angina in 8 cases (mortality 0%). Mortality in 8 cases whose infarct-related artery was left main trunk was as high as 63%. Eight of 9 cases whose cardiac indices were below 2.01/min/m2 immediately after the surgery died of pump failure. On the contrary, only 2 of 37 cases whose post-operative cardiac indices were above 2.01/min/m2 died of non-cardiac reason. To improve the surgical results, we concluded that powerful mechanical support such as ventricular assist system should be applied to post-operative pump failure cases whose cardiac indices were below this limit despite the aid of IABP.

Rat inwardly rectifying potassium channel Kir6.2: cloning electrophysiological characterization, and decreased expression in pancreatic islets of male Zucker diabetic fatty rats

The ATP-sensitive potassium channel of insulin-secreting pancreatic beta-cells is a complex of Kir6.2, a member of the inwardly rectifying potassium channel superfamily, and the sulfonylurea receptor. We have isolated cDNA clones encoding rat Kir6.2. Co-expression of rat Kir6.2 and sulfonylurea receptor in human embryonic kidney cells generated a potassium current with the properties of the beta-cell ATP-sensitive potassium channel. A quantitative reverse transcriptase-polymerase chain reaction assay indicated that Kir6.2 and sulfonylurea receptor mRNAs were abundantly expressed in rat islets and that expression of Kir6.2 mRNA was reduced by >70% in islets from Zucker diabetic fatty male rats, whereas there was no significant change in sulfonylurea receptor mRNA levels. Thus, decreased expression of Kir6.2 could contribute to the beta-cell dysfunction which characterizes diabetes mellitus in this animal model.

An approach for identifying simple sequence repeat DNA polymorphisms near cloned cDNAs and genes. Linkage studies of the islet amyloid polypeptide/amylin and liver glycogen synthase genes and NIDDM

Genetic factors contribute to the development of NIDDM, and genes involved in regulating pancreatic beta-cell function and insulin's effects on glucose metabolism are good candidates for being NIDDM susceptibility loci. However, testing candidate genes for linkage to NIDDM depends on the identification of highly informative DNA polymorphisms in or near the candidate locus. Here we describe an approach for identifying highly polymorphic markers near candidate genes that utilizes the emerging physical map of the human genome. A sequence-tagged site from the candidate gene is used to screen the Centre d'Etude du Polymorphisme Humain megabase-insert yeast artificial chromosome library, which contains information on the physical localization of >3,000 genetically mapped simple sequence repeat DNA polymorphisms. Thus, identification of a yeast artificial chromosome containing the candidate locus will in many instances also identify a physically linked simple sequence repeat DNA polymorphism that can be used as a marker for the candidate gene in linkage studies. We have used this approach to identify a marker for the islet amyloid polypeptide gene on chromosome 12. The physical mapping of this gene to a yeast artificial chromosome showed that it was in the same yeast artificial chromosome as the gene encoding liver glycogen synthase, another possible NIDDM susceptibility gene. Affected sib pair studies using a simple sequence repeat DNA polymorphism physically linked to the islet amyloid polypeptide and liver glycogen synthase genes showed no evidence for linkage with NIDDM, indicating that they are not major genes contributing to NIDDM susceptibility.

[Surgical results of total replacement of aortic root]

Total aortic root replacement was performed on 19 cases since December 1979 to May 1995. They were devided in two groups. First 7 cases were operated by original Bentall procedure with inclusion technique (group A). Succeeding 12 cases were operated by Carrel patch method or Cabrol procedure without inclusion maneuver. There were 2 operative deaths in group A (28.6%) and was one death in group B (8.3%) respectively. The operation time and the extracorporeal circulation time were significantly shorter in group A than that in group B. Anastomotic leakage was noted in 2 cases of group A. One of them required reoperation and another one with coronary ostial leakage died of congestive heart failure. We concluded that non-inclusion method for aortic root replacement was superior to conventional inclusion technique and reimplantation of both coronary ostia with Carrel patch method was the best tactics especially for Marfan syndrome in terms of long term results.

Detection of mRNA encoding guanylate cyclase A/atrial natriuretic peptide receptor in the rat cochlea by competitive polymerase chain reaction and in situ hybridization

Expression of mRNA encoding guanylate cyclase A (GC-A)/atrial natriuretic peptide (ANP) receptor in the rat cochlea was examined by polymerase chain reaction (PCR) and in situ hybridization (ISH). After reverse-transcription, PCR amplification, subcloning, and sequencing, we found that GC-A mRNA with sequence identical to that previously cloned from the rat brain (Chinkers et al., 1989) was expressed in the rat spiral ligament as well as in the spiral ganglion. However, GC-A mRNA was not detected in the stria vascularis. Competitive PCR using internal standard DNAs indicated that the expression of GC-A in the cochlea occurred at a level approximately 16 times less than that measured in kidney cortex. ISH histochemistry using a 35S-labeled antisense riboprobe showed the highest level of expression of GC-A mRNA to be in oligodendrocytes of the cochlear nerve root. The results suggest that ANP may play a role in the cochlear nerve function.

[Intrapleural bleomycin for management of malignant pleural effusions]

We studied the efficacy of intrapleural administration of bleomycin for the management of malignant pleural effusions of non-small cell lung cancer in 24 cases. Bleomycin 60 mg was administered into the pleural space after tube drainage. If the effusion continued, one additional dose was given. The efficacy was seen in 18 cases (75%). The main adverse drug reaction was transient fever among others. There was little toxicity and no cases of pulmonary fibrosis. Intrapleural administration of bleomycin is useful in management of malignant pleural effusions.

[Establishment of superoxide production assay system using Epstein-Barr virus transformed cell line with chemiluminescence]

We established the system to detect superoxide produced by Epstein Barr virus lymphoblastoid cell line (EB-LCL). Superoxide production of EB-LCL was evaluated by measuring chemiluminescence (CL) enhanced with addition of horseradish peroxidase (HRP). Using this system, we measured CL of EB-LCL established from 13 patients with chronic granulomatous disease (CGD) and 8 normal individuals. Significant elevation of CL was observed in all control EB-LCLs, however, no remarkable CL was seen in any patients' EB-LCLs. We examined the effect of recombinant human interferon gamma (rh-IFN-gamma) and granulocyte colony stimulating factor (G-CSF) on CL of EB-LCL in vitro. With addition of rh-IFN-gamma, CL of normal control EB-LCL was significantly enhanced (p < 0.05), on the other hand, G-CSF was shown to have no effect. No significant CL was observed in any CGD patients' EB-LCLs even with addition of rh-IFN-gamma or G-CSF. It was suggested that superoxide produced by EB-LCL detected in this system was dependent on the same NADPH oxidase system which presents in phagocyte.

Association of the prohormone convertase 2 gene (PCSK2) on chromosome 20 with NIDDM in Japanese subjects

Proinsulin is converted to insulin by the concerted action of two sequence-specific subtilisin-like proteases termed prohormone convertase 2 (PC2) and prohormone convertase 3. PC2 is a type II proinsulin-processing enzyme, and it cleaves the proinsulin molecule on the COOH-terminal side of dibasic peptide, Lys64-Arg65, which joins the C-peptide and the A-chain domains. We have previously cloned and characterized the exon-intron organization of the human PC2 gene (gene symbol PCSK2), localized this gene to human chromosome 20 band p11.2 by fluorescence in situ hybridization, and identified a simple tandem-repeat DNA polymorphism (STRP) in intron 2 of the form (CA)n, suitable for genetic studies. Since non-insulin-dependent diabetes mellitus (NIDDM) is associated with increased secretion of proinsulin and proinsulin-like molecules, we conducted a case-control study to determine whether a genetic variation in PCSK2 might contribute to the development of NIDDM. The study population consisted of 152 Japanese NIDDM subjects and 102 normal healthy nondiabetic control subjects matched for age and body mass index. The subjects were genotyped at the STRP in intron 2, and the results indicated a significant difference (P = 0.004) in the overall allele frequency distribution between the two groups. The A1 allele was found more frequently in NIDDM than in nondiabetic subjects (11 vs. 4%, P = 0.0068). The NIDDM patients were divided into two subgroups according to the presence or absence of the A1 allele.(ABSTRACT TRUNCATED AT 250 WORDS)

Enuresis in an adult female with obstructive sleep apnea

Adult onset enuresis accompanied by obstructive sleep apnea has been reported rarely. A female patient was referred to our clinic with complaints of of a 15-year history of loud snoring and sleep apnea as well as enuresis, which was treated successfully with imipramine and acetazolamide. The mechanism of enuresis and its relationship to upper airway obstruction are reviewed here with reference to the findings of polysomnography and sleep cystometry.

Cloning, expression and regulation of angiotensin II receptors

Angiotensin II isoform 1 (AT1) receptor cDNAs were cloned by expression cloning from bovine adrenal and rat vascular smooth muscles. Human AT1 receptor was also cloned. Seven transmembrane structures emerged. A single type of receptor seems to interact with more than one type of G-protein. AT1 consists of subtypes AT1A and AT1B, and the regulation of the receptors occurs at many stages. The isoform AT2 was also expression cloned from rat pheochromocytoma cells. Although its ligand binding is not affected by GTP analogs, it is a seven transmembrane domain receptor. It mediates the inhibition of phosphotyrosine phosphatase by angiotensin II and AT2 specific CGP42112A; the inhibition was abolished by pertussis toxin. Thus, AT2 belongs to a new class of angiotensin receptors with unique signalling and regulatory mechanisms.

[A case report of scimitar syndrome: a new technique in the correction of partial anomalous pulmonary venous drainage]

A twenty eight year-old man with anomalous pulmonary venous drainage from the right lung to the inferior vena cava (scimitar syndrome) underwent surgical treatment. We have successfully modified the surgical technique that consists of using the anterior wall of the right atrium, to form a tunnel that will divert the anomalous pulmonary vein to the left atrium. After rerouting of the anomalous pulmonary vein, the anterior wall of the right atrium was reconstructed with a polytetrafluoroethylene patch. To our knowledge, this is the first time this technique has been used to correct this syndrome.

Angiotensin II receptors: cloning and expression

To identify the mechanisms of action of isoforms angiotensin II receptors (AT1A, AT1B, and AT2) and to overcome the difficulties encountered in attempts to purify the receptors, we have expression-cloned their cDNAs from bovine and rat sources and isolated human cDNA and rat and human genomic DNA. The AT1A and AT1B cDNAs were found to encode respective receptor proteins with 359 amino acid residues, whereas, AT2 encodes a 363 amino acid residue receptor protein. Both AT1 and AT2 were found to conform with the seven transmembrane receptor structural motif, but showed only 32% amino acid residue identity to each other. The AT1 receptor was shown to be coupled to, at least, three different G proteins activating phospholipase C, inhibiting adenylyl cyclase and opening an L-type Ca(2+)-channel, whereas, AT2 was found to inhibit a phosphotyrosine phosphatase activity without affecting guanylyl cyclase by a pertussis-toxin-sensitive, presumably G-protein-mediated mechanism.

Mineralocorticoid type I receptor in the rat cochlea: mRNA identification by polymerase chain reaction (PCR) and in situ hybridization

Expression of mineralocorticoid type I receptor (MR) gene in the rat cochlea was determined using molecular biological techniques. We synthesized complementary DNA (cDNA) from rat cochlear total RNA and then amplified MR cDNA fragments by polymerase chain reaction (PCR). The amplified cDNA fragments were subcloned into an expression vector and the nucleotide sequence was analyzed to confirm the expression of mRNA encoding MR in the cochlea. We then synthesized digoxigenin-labeled riboprobes with this cloned DNA template and examined the localization of MR mRNA in the cochlea by in situ hybridization. The amino acid sequence of MR cDNA expressed in the cochlea was identical to that of the MR first cloned in the rat hippocampus. In situ hybridization showed the expression of MR mRNA in marginal cells of the stria vascularis, suggesting that aldosterone may regulate microhomeostasis of the endolymph, presumably by modulating Na, K-ATPase activity. Intense MR signal was also identified in spiral ganglion cells, the function of which remains to be determined.

Simple tandem repeat DNA polymorphism in the human glycogen synthase gene is associated with NIDDM in Japanese subjects

We investigated the possible association between alleles of a simple tandem repeat DNA polymorphism in the human glycogen synthase gene and non-obese non-insulin-dependent diabetes (NIDDM) in Japanese subjects. Nine alleles (-4G, -3G, -2G, -1G, 0G, 1G, 2G, 3G, and 4G) were identified in the study group of 164 patients with NIDDM and 115 non-diabetic subjects. The overall frequency distribution of the glycogen synthase gene alleles was significantly different between the two groups (p = 0.0316). The 2G allele was found more frequently in patients with NIDDM than in non-diabetic subjects (17.7% vs 8.7%, p = 0.0016). These results suggest that the 2G allele could be a genetic marker of NIDDM in Japanese subjects.

The genomic organization of human angiotensin II type 1 receptor

As a step toward the elucidation of human Ang II type 1 receptor gene expression, the genomic organization of the human AT1 receptor was investigated. Comparison of the genomic DNA and cDNA sequences revealed that it consists of at least five exons. The length of the AT1 receptor gene is greater than 55 kb, and the size of the exons ranges from 59 to 2,014 base pairs. Four of the exons encoded 5'-untranslated sequences. Multiple transcription initiation sites were observed by primer extension experiment. The promoter function was examined by using luciferase as a report gene in transfected human vascular smooth muscle cells.

Molecular genetic studies of two families with X-linked chronic granulomatous disease: mutation analysis and definitive determination of carrier status in patients' sisters

Molecular genetic studies of two families with X-linked chronic granulomatous disease (X-CGD) were performed. The patients showed abnormal patterns on Southern blot analysis using cytochrome b heavy chain (CYBB) cDNA as a probe. Both patterns differed and neither has ever been observed in normal individuals. We applied the results to the diagnosis of the carrier state in the patients' sisters. The results clearly demonstrated that each patient's sister possessed the same abnormal allele as the patient's CYBB gene, as detected by Southern analysis. Thus, the results confirm that both of the patients' sisters are carriers of the disease. Further molecular analysis of the patients' mutation revealed that they were a point mutation, and a partial deletion of the CYBB gene, respectively. These mutations have not previously been reported.

Case study of monosymptomatic delusion of unpleasant body odor with structural frontal abnormality

We report a 63-year-old man with a monosymptomatic delusion of unpleasant body odor contracted at the age of 61 years, who believed that his body reeked of some type of paint. He had symmetrical atrophy in the bilateral frontal lobes of unknown etiology on MRI. Further, quantitative rCBF measurement with SPECT brain scan using 99mTc-HMPAO showed relative hypoperfusion localized in the bilateral frontal lobes. EEG, neurological and neuropsychological tests were all normal, including the WAIS-R and Wechsler Memory Scale tests. However, he showed poor results on the Wisconsin Card Sorting test, presumably on account of frontal dysfunction, attaining only two categories with frequent perseverative errors. Although it is undetermined whether the illness in this case can be classified as organic delusional syndrome or paranoid disorder according to DSM-III-R criteria, these results imply that delusions are associated with frontal lobe abnormality.

Absorption activity and barrier properties in the endolymphatic sac. Ultrastructural and morphometric analysis

A constant volume of horseradish peroxidase (HRP) was injected directly into the endolymphatic sac (ES) lumen of the guinea pig to investigate the detailed absorption activity and the barrier properties of the ES. The reaction products were analyzed using an ultrastructural and morphometric method 1 to 10 h after the injection of this tracer. The epithelial cells in the proximal portion did not absorb the intraluminal HRP at any intervals after the tracer injection. The epithelial cells of the intermediate portion were classified clearly into two types according to their absorption activity: active-absorptive, and non-active cells. Uptake in the active-absorptive cells reached its maximal rate 8 h after the injection and then decreased. The active-absorptive cells in teh intermediate portion are considered to play a major role in the macromolecular absorption in the ES epithelium. The non-active cells scarcely absorbed the intraluminal HRP, suggesting that these cells are not involved in the macromolecular absorption. The absorption activity in the distal portion was lower than that in the active-absorptive cells in the intermediate portion 1 to 8 h after the HRP injection, while higher 10 h after the injection. Not only the intermediate portion but also the distal portion may play an active role in the macromolecular absorption. In no portion of the ES did intraluminal HRP penetrate beyond the junctional complexes between epithelial cells or through the cytoplasm. It is conceivable that there is a tight barrier to the intraluminal macromolecules in the epithelial linings of the ES.

[Appropriate administration of granulocyte colony stimulating factor for malignant lymphoma of the head and neck]

The effects of granulocyte colony stimulating factor (G-CSF) were evaluated in 9 patients with malignant lymphoma of the head and neck. The effects of 31 cycles of cytotoxic chemotherapy were treated with G-CSF. G-CSF was given by one of the following three routes: 1) administration before or with cytotoxic chemotherapy, 2) administration after cytotoxic chemotherapy with leukocyte counts of more than 2000/mm3, and 3) administration after leukocyte counts had dropped to less than 2000/mm3. The first group consisted of one cycle of CHOP therapy and 2 cycles of VAMA therapy. The second group consisted of 10 cycles of CHOP therapy. The third group consisted of 13 cycles of CHOP therapy and 5 cycles of VAMA therapy. Leukocyte nadirs occurred on around day 14 for CHOP therapy and around day 21 for VAMA therapy without G-CSF treatment. In the first group, the leukocyte nadirs occurred earlier with G-CSF treatment. Additional G-CSF treatments were given in two of the three cycles. In the second group, the leukocyte counts did not drop below 2000/mm3 in three of the ten cycles. Additional G-CSF treatments were given in five of the remaining seven cycles. The two other cycles went without additional treatment. The mean volume of G-CSF was 305 +/- 86 micrograms. In the third group, the leukocyte counts increased to more than 2000/mm3 immediately after G-CSF administration in CHOP therapy. The mean volume was 227 +/- 78 micrograms, significantly less than that of the second group. The leukocyte counts also exceeded 2000/mm3 3-5 days after G-CSF administration in 5 cycles of VAMA therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Angiotensin II receptors: cloning and regulation

Angiotensin II subtype 1 (AT1) receptor cDNA was cloned by expression cloning from bovine adrenal cortical cells. Human AT1 receptor was also cloned. These receptors were found to have a seven transmembrane structure. The receptor seems to interact with more than one type of G-proteins. AT1 consists of subtypes. cDNA for AT1A was cloned from rat kidney and that for AT1B was cloned from rat adrenal by plaque hybridization. They have similar base sequences in the coding region but are different in non-coding regions. Their functional implication is not clear. The regulation of the receptors occur at many stages. Expression of mRNA is studied in cultured rat mesangial cells. It was down regulated by angiotensin II and cAMP. On the other hand in whole body experiments, chronic infusion of angiotensin II was shown to upregulate adrenal AT1, and bilateral nephrectomy or losartan (CAS 124750-99-8) administration reduced AT1 mRNA expression. In addition to AT1 and AT2 the presence of a new subtype AT3 has been shown.

Efficacy of sulthiame (Ospolot) on motor partial seizure status during sleep in a patient with motor cortex epilepsy

An 18-year-old female patient with a particular form of intractable motor cortex epilepsy, in which motor partial seizure status occurred only during sleep every night, was reported focusing on the drastic efficacy of sulthiame on the seizure status. Moreover, the present study demonstrated that single photon emission computed tomography (SPECT) and pulse oximetry examinations, both of which were performed in the ictal state, were useful for the regional diagnosis of the epileptic focus and observations of the seizure frequency, respectively. The therapeutic effect, epileptic picture and clinical examinations described here appear to be relatively rare in the literature, and therefore, this case report may be of clinical significance.

Ultrastructure and barrier properties of the endolymphatic duct in the guinea pig

The ultrastructure and barrier properties of the endolymphatic duct (ED) were examined by light and electron microscopy. ED epithelial cells were classified into two types: type I and type II duct cells. The type I duct cells were cuboidal or low columnar and were characterized by a convex apical surface and a few basal processes. The type II duct cells were squamous and were characterized by a flat apical and basal membrane, many small vesicles and a number of small pits along the basal membranes. After electrophoretic horseradish peroxidase (HRP) injection into the ED lumen, no HRP uptake into ED epithelial cells of either type was observed. There was no reaction product either in the lateral intercellular spaces beyond the tight junctions between ED epithelial cells or in ED subepithelial tissues. The ED epithelial cells were considered to play no active role in apical macromolecular absorption and to be impermeable to intraluminal macromolecules.

Immunohistochemical localization of carbonic anhydrase in the endolymphatic sac of the mouse and guinea pig

The localization of carbonic anhydrase (CA) in mouse and guinea pig endolymphatic sac (ES) was determined by immunohistochemistry. In the distal and intermediate portions of the ES of both species, epithelial cells reacted with anti-CA antiserum. All epithelial cells in the distal portion stained for CA. In the intermediate portion, immunoreactivity was prominent in about half the epithelial cells, but less intense in the remaining epithelial cells. The proximal portion of the ES lacked immunoreactivity. CA may play a crucial role in ES electrolyte transport.

Diffuse cerebral hypoperfusion in epileptic patients observed from quantitative assessment with single photon emission computed tomography using N-isopropyl-(iodine-123)-p-iodoamphetamine

Quantitative assessment of regional cerebral blood flow (rCBF) in the bilateral cerebral and cerebellar cortices was performed in 15 epileptic adult patients receiving chronic high-dose antiepileptic drug therapy and 22 normal volunteers matched for sex and age, using single photon emission computed tomography with N-isopropyl-(iodine-123)-p-iodoamphetamine. The entire averaged rCBF value in the epileptic patients, i.e. 52.8 +/- 13.7 ml/10 g/min (range: 25-78 ml/100 g/min), was significantly lower as compared with that in the normal subjects, i.e. 69.1 +/- 14.2 ml/100 g/min (range: 46-102 ml/100 g/min). Six of the 15 patients showed absolute rCBF values less than the minimum of the normal range, i.e. 46 ml/100 g/min, in all or most of the measured brain tissues. There was a significant correlation between the diffuse cerebral hypoperfusion and simultaneous ingestion of phenytoin and phenobarbital. The possible effects of antiepileptic drugs on rCBF are discussed.

A Na pump inhibitor from bovine posterior pituitary: purification, structure determination and its cardiovascular effect in rat

We examined the hypothesis that hypothalamo-hypophysial tissue contains an endogenous Na pump inhibitor. From bovine posterior pituitary, we purified a substance which inhibits Rb uptake by human erythrocytes. This inhibitory activity was found in the eluate of 10% acetonitrile from a C18 flash column and purified by subsequent three steps of reversed-phase high-performance liquid chromatography (HPLC). Sequence analysis revealed that this substance was identical to joining peptide, one of the major products of proopiomelanocortin (POMC). This peptide had hypertensive and tachycardiac effects in spontaneously hypertensive rats (SHR) after central administration, with weak Na,K-ATPase inhibitory activity (IC50 = 0.5 mM).

Absorption of horseradish peroxidase in the endolymphatic sac: ultrastructural cytochemistry using a new electrophoretic technique

Using a newly developed injection technique, the absorption of horseradish peroxidase (HRP) in the endolymphatic sac (ES) of the guinea pig was examined by light and electron microscopy. HRP (molecular weight: 40,000; molecular diameter: about 5-nm) was directly injected into the lumen of the ES by electrophoresis after the recording of a direct current potential in the ES lumen. Both the macrophages floating in the ES lumen and the epithelial cells in the intermediate portion of the ES absorbed intraluminal HRP. The macrophages internalized the intraluminal HRP at a higher rate than the epithelial cells, suggesting that macrophages play a major role in macromolecular absorption in the ES. It was considered that the macrophages took up intraluminal HRP by phagocytosis, while the epithelial cells of the intermediate portion took it up by pinocytosis. In contrast, the epithelial cells in the proximal portion of the ES absorbed little HRP. No penetration through the junctional complexes between epithelial cells was observed in either the intermediate or the proximal portion at any interval after the injection of HRP. This finding indicates that these junctional complexes are impermeable to intraluminal HRP.

Analysis of the evolution of angiotensin II type 1 receptor gene in mammals (mouse, rat, bovine and human)

The nucleotide and amino acid sequences for mouse angiotensin II (AII) type 1A and 1B receptors were deduced from their complementary and genomic DNAs. Evolutionary analyses based on the nucleotide sequences of the coding region of AII type 1 receptor genes indicated that the duplication event of the type 1 gene occurred 24 +/- 2 million years ago before the divergence between the rat and mouse but after the divergence between rodents and the human/artiodactyls couple. This conclusion was consistent with the results of genomic Southern blot analyses, which revealed that the mouse and rat possess 2 similar but separate genes, whereas the bovine and human have only a single class gene.

Molecular cloning, sequence analysis and expression of a cDNA encoding human type-1 angiotensin II receptor

We isolated a cDNA encoding type-1 angiotensin II receptor from a human liver cDNA library. The cDNA had an open reading frame encoding a protein of 359 amino acid residues with a relative Mr of 41,060. The deduced amino acid sequence of the human angiotensin II (Ang II) receptor was 95.3% and 94.2% identical to those of bovine and rat type-1 Ang II receptors, respectively, and had a significant similarity with the G protein-coupled receptor. The rank order of the binding to the receptor expressed in COS-7 cells was Ang II greater than Ang III greater than Ang I. The expression of the Ang II receptor mRNA was detected in human liver, lung, adrenal and adrenocortical adenomas but not in adrenomedullary tumor, pheochromocytoma, by Northern blot analysis.

Molecular cloning and sequencing of the gene encoding human angiotensin II type 1 receptor

The gene of human angiotensin II type 1 (AT1) receptor was isolated from a lymphocyte genomic library. The coding region of the human AT1 receptor gene was contained in a single exon coding segment of the gene indicating an intronless structure of the coding region. The amino acid sequence of human AT1 receptor deduced from its base sequence has 359 amino acids and showed a high degree of sequence identity to bovine and rat AT1 receptor sequences. Amino acid substitutions specific to the human AT1 receptor were mostly confined to the carboxy terminal half of the molecule. The seven-transmembrane domains are well-conserved in those sequences.

Islet amyloid polypeptide (IAPP/amylin) causes insulin resistance in perfused rat hindlimb muscle

It has been reported that islet amyloid polypeptide (IAPP) has insulin antagonistic effects in vivo and in vitro. To determine whether IAPP affects glucose metabolism in skeletal muscle, we performed in situ rat hindlimb perfusion which is a near-physiological system. Forty min after the beginning of insulin infusion at 1000 microU/ml, the synthesized rat amide form of IAPP was infused at 1 nM or 10 nM for 50 min and glucose concentration in the effluent was measured to calculate glucose uptake (GU). The GU did not change during the 1 nM IAPP infusion, but significantly decreased during 10 nM IAPP infusion (554 +/- 24 to 445 +/- 29 nmol/g/min, P less than 0.01). Rat calcitonin gene-related peptide (CGRP), which has sequence homology with IAPP and has been reported to inhibit insulin action, was also administered. Similar to the effect of IAPP, the GU did not change during 1 nM CGRP infusion but significantly decreased during 10 nM CGRP infusion (507 +/- 7 to 323 +/- 15 nmol/g/min, P less than 0.01). In the experiments without insulin infusion, the GU was not changed even by 10 nM IAPP infusion. Therefore, IAPP directly reduced only the insulin-mediated GU in the skeletal muscle, and this effect of IAPP occurred at the same dose as that of CGRP. These data suggest that both IAPP and CGRP may cause insulin resistance in skeletal muscle not through a CGRP receptor but a yet unknown receptor, which has similar binding affinity for both IAPP and CGRP.

Penta X syndrome: a case report with review of the literature

We describe a 6 month-old girl with a 49, XX-XXX chromosome constitution. The patient had a characteristic round face, a low hairline, hypertelorism, epicanthus, a long philtrum, high-arched palate, short and webbed neck, small hands and feet, clinodactyly of the fifth fingers, overlapping toes, and separation between the first and the second toes. She also had atrial septal defect and patent ductus arteriosus complicated by myocarditis which exacerbated the course of her congestive heart failure. Psychomotor development was retarded with opisthotonoid posture, axial hypotonia, and with a borderline abnormal EEG. A densitometric, transmission analysis on X-linked polymorphic DNA-fragments of the Southern blots of the patient and the parents, using P20/MspI and pERT87-1/XmnI as probe/enzyme combinations, showed that the pentasomy X had resulted from 3 successive nondisjunctions at maternal meiosis. Clinical manifestations among 22 previously reported penta X syndrome patients are also reviewed.

A case of epilepsy characterized by spike-wave stupor followed for long period

A 34-year-old housewife with nonconvulsive status epilepticus was followed up for 20 years since the initial fit. She maintained some contact with reality during the stupor and recalled the episode to some extent, while the EEG showed continuous spike-wave complexes. During the clinical course, the main type of seizures was spike-wave stupor, of which the maximum frequency was several times a week in the hospital and the duration was many minutes to several hours, and also secondarily generalized convulsive seizures occurred approximately once a month. The lasting control of spike-wave stupor was not achieved in spite of the various medications for the long follow-up period. The ictal EEGs of spike-wave stupor always showed the frontal origin. The meaning of the term "nonconvulsive status epilepticus" in this case was briefly discussed.

[A case of so-called neoplastic angioendotheliosis with fever of unknown origin and temporary loss of consciousness]

A 65-year-old man was hospitalized with prolonged fever. The erythrocyte sedimentation rate was 62 mm/hour and the c-reactive protein was 5+. Serum lactic dehydrogenase was 1005 IU with elevation of isozyme types II and III. A computerized tomography scan of the abdomen showed large, bilateral adrenal masses. An aspirated specimen of the bone marrow revealed some clustered atypical cells. These findings suggested the patient had metastatic carcinoma, but the primary lesion could not be found. The patient had an episode of transient unconsciousness in mid course and died of bleeding from the gastrointestinal tract. A postmortem examination was performed. Microscopic examination showed an accumulation of neoplastic cells in the vascular system throughout the body and their extravascular proliferation in several organs. Immunohistochemical studies were performed on paraffin-embedded fixed tissues. The neoplastic cells were positive with the monoclonal antibodies LCA, LN 1, LN 2 and N 26 but did not show positive staining for factor VIII-related antigen, a marker for endothelial cells. These studies defined the neoplastic cells as being of a germinal-center B lymphocyte origin. On the basis of the above-mentioned results, we suggest that this case may be diagnosed as angiotrophic lymphoma.

Ultrastructure of the endolymphatic sac in the mouse

The ultrastructure of the endolymphatic sac (ES) in the mouse was examined by light and electron microscopy. This organ was divided into three parts: proximal, intermediate and distal. In the proximal portion of the ES, the epithelium consisted of thin squamous cells. The epithelial cells had acquired basolateral processes, numerous small vesicles and well-developed Golgi apparatus. In the intermediate portion, the epithelium consisted of columnar or cuboidal cells. The epithelial cells could be classified into two types: type I and type II. The type I cells had abundant microvilli, pinocytotic vesicles, vacuoles, multivesicular bodies, lysosomes and mitochondria. The type II cells had fewer numbers of these organelles. A few free-floating cells could be observed in the lumen of this intermediate portion, most of which were macrophages. In the distal portion, the epithelium consisted of squamous or cuboidal cells. The epithelial cells had a few cytoplasmic organelles. In the ultrastructural study, each portion of the mouse ES was found to have a very distinct morphological feature. It was suggested that each of these three portions has a different function.

Capillary permeability and basolateral endocytic pathway of the epithelium in the mouse endolymphatic sac in vivo

The capillary permeability and the basolateral endocytic pathway of the mouse endolymphatic sac (ES) epithelium were examined in vivo using intravenous injection of horseradish peroxidase (HRP). The capillaries of the ES were classified as either fenestrated or non-fenestrated. Because dense reaction products were observed soon after injection of HRP in macrophages near both types of capillaries, they were both considered to be permeable to macromolecules. In non-fenestrated capillaries, the basement membrane and small vesicles of the endothelium of the ES were stained with reaction product. These non-fenestrated capillaries were considered to be of muscle type. After 15 min, ES epithelial cells absorbed HRP basolaterally, and the multivesicular bodies and lysosomes of epithelial cells were stained with reaction product. The process of basolateral absorption in the ES epithelium was similar to that in the intestinal epithelium. Our results provide further evidence that the ES is a metabolically active organ which plays an important role in fluid transport in the inner ear.

Cytolytic action of Vibrio vulnificus haemolysin on mast cells from rat peritoneal cavity

The mode of action of Vibrio vulnificus haemolysin (VVH) on mast cells from the peritoneal cavity of the rat was examined. VVH induced histamine release, and damage to the mast cells, in a dose-dependent fashion. When 1 microgram of VVH was added to c. 10(5) mast cells at 37 degrees C, histamine release was observed after a lag period of 5-10 s, and was complete within 5 min. The action was temperature-dependent, and was not induced at 4 degrees C. Disodium cromoglycate, a membrane stabiliser for mast cells, inhibited the histamine release significantly, but the effect was not dose-dependent. Moreover, leakage of lactate dehydrogenase from VVH-treated mast cells was observed. These results suggest that VVH acts on the cell membrane of mast cells and is cytolytic.