[Bilateral non-Hodgkin's lymphoma of the adrenal glands with adrenal insufficiency]

A 66-year-old female presented with anorexia, fatigue, skin pigmentation, weight loss and low grade fever. Imaging studies demonstrated bilateral bulky masses confined to the adrenal glands. Ultrasonography guided needle biopsy of the mass showed findings of diffuse large B-sell lymphoma. Low levels of serum cortisol, urinary 17-OHCS and 17-KS, a high level of ACTH and a non-reactive pattern on the rapid ACTH test led to a diagnosis of Addison's disease. Only a partial regression was achieved by the first chemotherapy. She died due to disease progression, while the next course of chemotherapy had been postponed because of interstitial pneumonitis due to methotrexate.

Inhibition of basophil histamine release by a haptenic peptide mixture prepared by chymotryptic hydrolysis of wheat flour

For application to the treatment of wheat-sensitive allergy, we developed a practical method for producing a haptenic peptide mixture, and evaluated its haptenic properties. Wheat flour was hydrolyzed with chymotrypsin to obtain a hydrolysate, and the diffusible fraction from the hydrolysate was subjected to gel-filtration. The resulting oligopeptide fraction could bind to wheat-specific IgE antibodies in the serum of patients allergic to wheat. Since this peptide mixture did not induce histamine release from basophils in these patients, it was concluded that the peptide mixture was composed of monovalent haptens. Histamine release from antigenstimulated basophils was almost completely inhibited when the basophils were preincubated with the haptenic peptide mixture. These results suggest that this haptenic peptide mixture can regulate the allergenic reaction in an epitope-specific manner.

A major wheat allergen has a Gln-Gln-Gln-Pro-Pro motif identified as an IgE-binding epitope

The minimum primary structure of the IgE-binding epitope in wheat gluten was determined as Gln-Gln-Gln-Pro-Pro. The N-terminal glutamine and the two proline residues were essential for epitopic function. The occurrence of the second glutamine residue and acetylation of the N-terminal amino group were found to exert some auxiliary functions, whereas only a lesser contribution was expected for the third glutamine residue. It has also been confirmed that acetyl-Gln-Gln-Gln-Pro-Pro bound to wheat-specific IgE antibodies in the sera of patients allergic to wheat, although it did not induce histamine release from the basophils of these patients. Taken together, we concluded that the Gln-Gln-Gln-Pro-Pro motif constituted an IgE-binding rather than immunogenic epitope and also that acetyl-Gln-Gln-Gln-Pro-Pro might act as a hapten capable of binding to specific IgE molecules. The possibility exists that this peptide will have practical application to therapy for or prevention of wheat-sensitive allergy.

Significance of the cant of the posterior occlusal plane in class II division 1 malocclusions

In studying a group of fifty adult females with Class II division 1 malocclusion, it was evident that the skeletal problems of this malocclusion involved small, retruded mandibles accompanied by backward rotation. This skeletal pattern was considered to be influenced by the vertical dimension of the upper dentition in the buccal segment for mandibular function. The anterior and the posterior occlusal planes were examined to gain a detailed assessment of the relationship between the dental and the skeletal patterns. The findings indicated that the steep cant of the posterior occlusal plane was strongly correlated with the following: 1. Small, retruded mandible with backward rotation as the skeletal pattern. 2. Short vertical height of the upper second molars and distal inclination of the upper molars as the dental pattern. The increased vertical height of the lower second premolars was found to be related to backward rotation of mandible. In treating skeletal Class II malocclusions, this study indicated that control of the vertical dimension of the posterior teeth is extremely important.

IgE-mediated basophil releasability is influenced by intrinsic factors and by IgE on the cell surface

Experiments were done to clarify the mechanisms associated with releasability of histamine. First, washed leukocytes from 23 asthmatic patients sensitive to mite allergen were challenged with Der p 1, a major allergen isolated from Dermatophagoides pteronyssinus, or anti-IgE. A significant correlation was observed between the ratio of Der p 1-specific IgE titer to total IgE level (S/T) in the patient's plasma and either the reactivity (maximal percentage of histamine release; rs = 0.514, P = 0.016, n = 23) or the sensitivity (the minimum allergen concentration required to achieve 25% histamine release; rs = -0.790, P = 0.0002) to Der p 1. Additionally, the reactivity to Der p 1 was significantly correlated with that to anti-IgE (rs = 0.690, P = 0.0012), indicating that an intrinsic cellular property may be one of the contributing factors in immunologic histamine release. In a second series of experiments, sinus mast cells were passively sensitized with immunoglobulins prepared from the patient's plasma. A statistically significant correlation was found between either the reactivity or the sensitivity to Der p 1 and S/T, thus indicating that S/T is an indicator of the releasability of histamine. When basophils or mast cells were passively sensitized with mouse IgE and subsequently stimulated with antimouse IgE, the reactivity to antihuman IgE was significantly correlated with that to antimouse IgE (rs = 0.966, P = 0.0023, n = 11). These observations suggest that an intrinsic cellular property regulates reactivity in immunologic histamine release. Taken together, our results suggest that an intrinsic cellular property, as well as specific IgE antibody levels on the cell surface, is an important factor in determining histamine release in response to IgE-dependent activation.

Comparison of anti-allergic activities of the histamine H1 receptor antagonists epinastine, ketotifen and oxatomide in human leukocytes

The effects of three histamine H1 receptor antagonists, epinastine (CAS 80012-43-7, WAL-801 CL), ketotifen (CAS 34580-13-7) and oxatomide (CAS 60607-34-3), on mediator release have been studied in human peripheral leukocytes. When leukocytes from asthmatic patients sensitive to mite were stimulated with the allergen, epinastine inhibited histamine release with a concentration required for 50% inhibition (IC50) of 3 x 10(-5) mol/l and leukotriene C4 generation. On the other hand, ketotifen or oxatomide showed little inhibiting effect on histamine release elicited with the allergen. When the cells were stimulated with calcium ionophore A23187, epinastine failed to inhibit histamine release and leukotriene C4 generation. Oxatomide caused a concentration related inhibition of calcium ionophore-induced histamine release with the IC50 value of 5 x 10(-5) mol/l. Ketotifen or oxatomide also showed an inhibition of leukotriene C4 generation induced by calcium ionophore in a dose-dependent manner and the IC50 value was 6 x 10(-6) mol/l for oxatomide and 8 x 10(-5) mol/l for ketotifen, suggesting that oxatomide is a more potent inhibitor of leukotriene C4 generation than ketotifen. These results indicate that epinastine inhibits IgE-mediated histamine release and LTC4 generation, and oxatomide has a capacity to inhibit calcium ionophore-induced mediator release from human leukocytes. Additionally, when platelet activating factor was quantitated by radioimmunoassay in the supernatant and the cell pellet after ionophore stimulation, epinastine inhibited the formation and the secretion in a dose-dependent manner.

Atopic asthma caused by Candida albicans acid protease: case reports

Two cases of atopic asthma caused by acid protease produced by Candida albicans are reported. Both patients had high levels of serum IgE antibodies against the acid protease and showed positive conjunctival and immediate bronchial responses when challenged with the protease. Significant histamine release was detected in both patients when their peripheral leukocytes were challenged with the protease antigen. These findings clearly showed that C. albicans acid protease is the causative allergen of atopic asthma.

[Interleukin-5-induced generation of superoxide by eosinophils in asthma]

Superoxide generation was assessed in highly purified eosinophils (> 99.0% pure) with a flow cytometer. Eosinophils from patients with asthma were collected by centrifugation of leukocytes on Percoll density gradients, followed by negative immunoselection with anti-CD16 monoclonal antibodies. For comparison, highly purified neutrophils (< 99.5% pure) were collected by a similar method with anti-CD9 monoclonal antibodies. After incubation with a fluorescent probe, the cells were stimulated with various concentrations of PAF, PMA or various cytokines. Both eosinophils and neutrophils generated superoxide dose-dependently in response to PAF and PMA. Eosinophils generated superoxide in response to IL-3 and IL-5 (maximum concentration was 50 ng/ml), but neutrophils did not. IL-5-induced superoxide generation was lower in the presence of IL-5 antibodies. After stimulation with PMA, superoxide generation was significantly higher in neutrophils than in eosinophils (p < 0.05). There were no significant differences in PAF-induced or GM-CSF-induced superoxide generation between eosinophils and neutrophils. After stimulation with the optimal concentration of IL-5 or PMA, eosinophils with a lower density generated significantly more superoxide than those with a higher density.

[Release of chemical mediators in the conjunctival lavage fluids after eye provocation with allergen or compound 48/80]

Allergen extract was used to perform conjunctival provocation test on patients with Japanese cedar pollen conjunctivitis during the off-season, and histamine, tryptase and immunoreactive-leukotriene C4 (i-LTC4), which mainly consisted of LTE4, were measured in the lavage fluids. The results obtained in this study were as following. 1) After instillation of the allergen extract (1:20, w/v, 0.01 ml), histamine reached a maximal level of 4.63 +/- 1.67 ng/ml (mean +/- SE, n = 11) at 5 min. Tryptase appeared more slowly and the peak levels were reached at 5 min (116.6 +/- 49.6 ng/ml) or 10 min (119.4 +/- 63.8 ng/ml). In another set of the experiments, histamine peaked at 5 min (3.84 +/- 1.08 ng/ml, n = 7), and i-LTC4 reached peaks at 5 min (320 +/- 44.4 pg/ml) or 10 min (367 +/- 64.8 pg/ml). The amounts of these mediators decreased to base-line levels by 30 min. 2) The amounts of histamine retrieved from the lavage fluid were significantly correlated with those of tryptase (r = 0.819, p < 0.01, n = 11) and the weight ratio of tryptase to histamine was 41.2 +/- 10.0. These observations suggest that histamine was released from mast cells. 3) A significant correlation between the levels of histamine and i-LTC4 recovered from the lavage fluids was also observed (r = 0.736, p < 0.05, n = 7). 4) Compound 48/80 was instilled in the right eye (7.5 mg/ml, 0.01 ml) and the left eye was given allergen solution.(ABSTRACT TRUNCATED AT 250 WORDS)

[Clinical evaluation of whole blood histamine release test simultaneously testing multiple allergens--correlated with bronchial provocation test]

We compared the efficacy of the novel histamine release test (HRT), which allows the determination of many allergens at the same time using a small amount of whole blood, with other conventional allergen diagnostic tests. HRT and RAST were both performed along with bronchial provocation tests (BPT) on 44 bronchial asthma patients in whom the etiologic allergen could not be determined by either intracutaneous tests (ICT) or ophthalmic response tests (ORT). The HRT uses a microtiterplate on which glass fibers have 10 kinds of allergens affixed. The histamine release ability at 6 different concentrations of each kind of allergen was examined. The concordance of HRT with respect to BPT was the highest at 82% in comparison with RAST at 66%, ICT at 55% and ORT at 60%. With each of the allergens, HRT had the highest concordance with BPT. On the other hand, RAST, ICT and ORT showed different results depending on the allergens. The positive predictive value of HRT was the highest at 76% compared with RAST at 59%, ICT at 51% and ORT at 64%. From these results, we concluded that HRT is a more useful diagnostic method for the confirmation of a clinical allergy than other conventional diagnostic methods.

[Fundamental studies on the measurement of urinary leukotriene E4]

We undertook fundamental studies on the measurement of urinary leukotriene E4, a stable end-product of peptidoleukotrienes, and obtained the following results. 1) After addition of 3H-LTE4 to 2 ml of urine, LTE4 was extracted with a commercial C18 mini-column, and purified by high performance liquid chromatography and then LTE4 in the elute was measured with an enzyme immunoassay kit. 2) As total recovery of LTE4 was 35.3 +/- 0.9% (n = 76), the amount of LTE4 was calculated after correction of the recovery with 3H-LTE4. 3) Before extraction of LTE4 by C18 column, the column was washed by ethyl acetate to remove interfering substances. This procedure greatly facilitated the following high performance liquid chromatographic analysis. 4) The basal levels of urinary LTE4 of seven aspirin-sensitive asthmatics were elevated as compared with five asthmatics without aspirin sensitivity (358.9 +/- 114.0 versus 77.9 +/- 47.3 pg/mg.cr; p < 0.05). 5) In two asthmatic patients, improvement of their symptoms was accompanied with decrease in the LTE4 level in urine. This method enabled us to measure LTE4 concentrations in a small volume of urine (2 ml), and would be useful for evaluating the pathogenesis of bronchial asthma.

[The allergic reaction to acid protease released by Candida albicans]

The species of Candida albicans (C. albicans) are known to colonize mucocutaneous regions as part of the endogenous flora. C. albicans is also known as an important allergen in human allergic diseases. However, the major allergen of C. albicans has not been identified yet. Acid protease released from C. albicans (CAAP) cleaves IgA or the secretory component to enable C. albicans to colonize on the mucous membrane. In this study, using CAAP and crude Candida antigen as challenging antigens, we carried out conjunctival provocation tests (CPT) on 68 adult bronchial asthmatic patients who showed immediate positive skin reactions to crude Candida antigen. In several patients we performed serum IgE antibody (RAST), histamine release from peripheral leukocytes (HRT) and bronchial provocation tests (BPT) to CAAP. Six of the 8 patients who showed positive CPT to crude Candida antigen (75%) showed positive CPT responses to CAAP. On the other hand, only 1 of the 59 patients who showed negative CPT to crude Candida antigen (1.7%) showed positive CPT reactions to CAAP. Two female patients showed positive RAST and HRT to both crude Candida and CAAP. They also showed positive CPT and BPT. One patient had positive RAST results but negative HRT, CPT and BPT results. These results show that CAAP is an important allergen for atopic patients allergic to C. albicans.

Purification of human blood basophils and leukotriene C4 generation following calcium ionophore stimulation

A simple method for purification of basophils from a relatively small volume of blood has been developed, which enables us to collect basophils with a purity of over 80%. Basophils were partially purified from 10-20 ml of citrated whole blood using the discontinuous Percoll density gradient centrifugation technique and then contaminant cells were removed using monoclonal antibodies against CD2, CD19, CD14 and CD16. At the end of the procedure, basophils were > 80% pure with lymphocytes accounting for most of the contaminating cells. When stimulated with anti-IgE or fMLP, histamine release from purified basophils was similar to that from mixed leukocytes. When highly purified basophils were challenged with calcium ionophore A23187, generation of leukotriene C4 (LTC4) was not significantly different between asthmatic patients and normal subjects (45.6 +/- 22.6 vs 52.7 +/- 25.6 ng/10(6) cells). Basophils were capable of generating LTC4 in approximately the same quantities as eosinophils (46.5 +/- 11.7 ng/10(6) cells, n = 3). Furthermore, it has been shown that incubation of basophils and eosinophils with calcium ionophore generates only small quantities of thromboxane B2 (TXB2).

[Clinical usefulness of histamine release test in determining allergens in food hypersensitivity]

We examined the clinical usefulness of three diagnostic tests including the histamine release test, RAST and prick test in determining which of a total of 349 allergens were responsible for individual cases of food hypersensitivity. The subjects were 42 children (mean 3.3 years old). When compared with the results of the offending allergen confirmed by elimination and provocation test, each diagnostic test showed a fairly good correlation in percentage agreement and negative agreement, but there was poor correlation in positive agreement (histamine release test 58.1%, RAST 62.8%, prick test 48.8%). False positive results were more frequently observed in RAST (12.6%) as compared with the histamine release test (4.0%) and prick test (2.3%). McNemar's analysis demonstrated that the histamine release test, but not RAST or the prick test, was matched the diagnosis by elimination and provocation test (alpha = 0.30). These results suggest that the histamine release test is more clinically useful than RAST or the prick test in the diagnosis of food hypersensitivity.

Allergens from Dermatophagoides mites with chymotryptic activity

A new set of allergens from Dermatophagoides pteronyssinus and D. farinae (provisionally named DP5 and DF5, respectively) was isolated from the whole culture of mites. The apparent molecular weights of both allergens were shown to be 25,000 on SDS-PAGE under a reducing condition and 27,000 on Sephadex G-75 gel filtration chromatography. Both DP5 and DF5, as well as Der f III, possessed proteolytic activity. The results of substrate specificity and susceptibility to various protease inhibitors of DP5 and DF5 strongly suggested that they belonged to the chymotrypsin-like serine protease family. In sera from 88 mite-allergic patients, specific IgE antibodies to DP5 and/or DF5 were detected in only 41% of the sera by radio-allergosorbent test, while 90% and 93% had specific IgE antibodies to Der p I and/or Der f I and Der p II and/or Der f II, respectively.

Effect of butyric acid on induction of differentiation into eosinophil-like cells in human eosinophilic leukemia cells, EoL-1 cell line: possible role of granulocyte-macrophage colony-stimulating factor as an autocrine differentiating factor

EoL-1 cells differentiated into mature eosinophil-like cells when incubated with butyric acid (BA). The differentiated cells possessed many granules that stained with Luxol fast blue and acquired the ability to produce leukotriene C4 and eosinophil cationic protein (ECP), and migrated toward some eosinophillotactic attractants, including PAF, IL-5, IL-3 and GM-CSF. Monoclonal antibody to GM-CSF and IL-5, especially GM-CSF, strongly decreased the ability of BA to induce differentiation, whereas antibody to IL-3 did not. Recombinant human (rh) IL-3, rhGM-CSF and recombinant mouse (rm) IL-5, by themselves, did not have the ability to induce differentiation. On the other hand, the presence of these cytokines significantly (p < 0.01) augmented BA-induced cell differentiation. Other cytokines including rhIL-1 alpha/beta, rhIL-2, rhIL-4, rhIL-6, rhIL-8, rhTNF-alpha and rhIFN-gamma had no effect on differentiation. Expression of GM-CSF and GM-CSF receptor mRNA was detected in cellular RNA obtained from BA-stimulated EoL-1 cells. Moreover, about 5-10 pg/ml of GM-CSF was detected in the culture supernatant of BA-stimulated EoL-1 cells. These findings suggested that BA-induced EoL-1 cell differentiation was elicited under the influence of GM-CSF endogenously produced in these cells. GM-CSF also seemed to be an autocrine differentiating factor in EoL-1 cells.

Further characterization of dispersed human sinus mast cells

We have examined biochemical and functional characteristics of dispersed sinus mast cells and compared them with those of mast cells dispersed from other tissues. This experiment yielded the following results. 1) Although no difference was observed in histamine content, tryptase content in sinus mast cells was significantly lower than that of skin and lung mast cells. 2) In contrast with the situation in foreskin mast cells, anti-IgE-induced histamine release from sinus and lung mast cells was potentiated with lower concentrations of adenosine. 3) Similar to lung mast cells, sinus mast cells did not respond to compound 48/80 or substance P, whereas skin mast cells were stimulated to release histamine with either 10 micrograms/ml of compound 48/80 (14.0%) or 10(-4) M of substance P (23.4%). 4) Sinus mast cells are similar to lung mast cells in terms of release of arachidonic acid metabolites. Anti-IgE challenge of sinus mast cells caused the generation of both prostaglandin D2 (89.5 +/- 33.7 ng/10(6) mast cells, n = 14) and i-leukotriene D4 (78.7 +/- 46.8 ng/10(6) mast cells, n = 10).

PAF-induced eosinophilic and basophilic differentiation in human hematopoietic precursor cells

PAF enhances the maturation and differentiation of basophils and eosinophils from hematopoietic precursor cells. These enhancing effects of PAF were inhibited by PAF antagonists, such as WEB-2086. Also, the coexistence of antibodies to IL-1 and IL-3 markedly inhibited the PAF-induced differentiation. Human recombinant IL-1 alpha/beta induced differentiation of hematopoietic precursor cells into both cell lines, and this was completely inhibited by the coexistence of antibody to IL-3. Interleukin 1 beta and IL-3 were detected in the cultured supernatant of PAF-stimulated mononuclear leukocytes obtained from human umbilical blood. From these findings, it is suggested that PAF triggers the production of these growth factors via specific receptors, and the growth factors produced may directly cause the differentiation and maturation of the precursor cells.

[The diagnostic value of a new whole blood histamine release test using paper disc-coupled antigens--results compared with intracutaneous test, RAST, and eye test]

We have developed a novel histamine release test (HR) using whole blood and antigen-coupled RAST paper discs, for the screening of allergens rather in a short time with a small amount of blood. Histamine was determined by a RIA kit. In order to evaluate the diagnostic value, the results of the test were compared with those of RAST, intracutaneous tests, and eye tests in 45 allergic patients. HR correlates better with RAST than intracutaneous test in almost all antigens. The closest positive correlation with the other tests was seen in mite allergen, followed by pollen, foods and mould spores in that order. When the HR was positive for house dust, 100% of the patients were also positive for the eye test, which is reported to closely correlate with bronchial provocation tests. HR seemed to be a useful test not only for the screening but also for the determination of pathogenic allergens.

Enzymatic dispersion of mast cells from human sinus mucosa: characterization of histamine release and its comparison with chopped fragments of the tissue

Functional characteristics of mast cells in chopped fragments from sinus mucosa, which was dissected from patients with chronic sinusitis, were compared with those from dispersed cells prepared by enzymatic treatment. The results obtained in this study were the following. (1) Both chopped fragments and dispersed cells released histamine in a dose-dependent manner when incubated with anti-IgE. However, higher histamine release was always observed in dispersed cells. (2) Although no differences in the ability to reduce histamine release with salbutamol or forskolin could be observed between chopped fragments and dispersed cells, staurosporin and p-bromophenacyl bromide were more active on dispersed mast cells than chopped fragments. (3) Passive sensitization of dispersed cells with an allergic serum containing IgE to mite could be achieved only after elution of IgE on the cells with lactic acid.

Histamine release with a solid-phase-coupled allergen

Mite allergen was coupled to Sepharose, paper disk or microcrystalline cellulose, and the immobilized allergen was used for histamine release assay in human leukocytes. In terms of the spontaneous release and the reproducibility, the histamine release assay using immobilized allergen was comparable to that using soluble allergen. Histamine release increased progressively with the concentration of the immobilized allergen up to maximal release of histamine which persisted with further increase in immobilized allergen. Histamine release with soluble allergen decreased at higher concentrations of the allergen. The concentration of immobilized allergen required for maximal histamine release was the same as that with soluble allergen, but the maximal release with immobilized allergen was always about 20% lower than that with soluble allergen. Histamine release was not dependent on the density of allergen molecules on Sepharose beads. Although there was a significant correlation between histamine release obtained with a commercial disk, with a disk prepared in our laboratory, and with soluble allergen, the magnitude of the release by both assays using a paper disk was reduced significantly.

Identification of proteins encoded in Escherichia coli hydA, hydB and analysis of the hydA locus

The hydB gene of Escherichia coli, which is related with the expression of hydrogenase activity, was cloned into the plasmid (pES1). Using the maxicell protein-labeling method, the molecular weight of hydB gene product was estimated. Comparing between the gene products from the mutant strains and that of the hydB genes cloned strains, the molecular weight of the gene product was 35,000 Mr. Similarly, the molecular weight of the gene product of hydA, which had been previously cloned, was determined by maxicell analysis. The molecular weight of hydA gene product was estimated to be 80,000 Mr. Using deletion analysis and Tn1000 insertional inactivation of hydA's function, the hydA coding region was estimated between 2.2 kb and 2.8 kb in a 3.1 kb EcoRI-MluI fragment on the recombinant plasmid pEH3.

Quantitation of platelet-activating factor by high-performance liquid chromatography with fluorescent detection

Platelet-activating factors, 1-O-hexadecyl- and 1-O-octadecyl-2-acetyl-sn-glycero-3-phosphocholine (C16-AGEPC and C18AGEPC), were measured by reverse-phase high-performance liquid chromatography with fluorescent detection. C16AGEPC, C18AGEPC, and 1-O-hexadecyl-2-propionyl-sn-glycero-3-phosphocholine, which was suitable for use as an internal standard, were hydrolyzed with phospholipase C, and then the resulting hydrolyzed products were derivatized with 7-methoxycoumarin-3-carbonyl chloride or 7-methoxy-coumarin-4-acetic acid to form 7-methoxycoumarin ester derivatives which permit a fluorometric detection. The lower limit of detection of the derivatives was about 100 pg at a signal-to-noise ratio of 5:1. A commercial platelet-activating factor was demonstrated to contain C16AGEPC (70%) and C18AGEPC (12.8%) by the present method. The present method was also applicable to the measurement of acetyl-CoA:1-alkyl-2-lyso-sn-glycero-3-phosphocholine acetyltransferase activity in a lysate of human polymorphonuclear leukocytes.