Erythropoietin-independent erythrocyte production: signals through gp130 and c-kit dramatically promote erythropoiesis from human CD34+ cells

Erythropoietin (EPO) is the primary humoral regulator of erythropoiesis and no other factor has previously been reported to support proliferation and terminal maturation of erythroid cells from hemopoietic stem cells. Here we show that stimulation of glycoprotein (gp130) by a combination of recombinant human soluble interleukin 6 receptor (sIL-6R) and IL-6 but not sIL-6R or IL-6 alone can support proliferation, differentiation, and terminal maturation of erythroid cells in the absence of EPO from purified human CD34+ cells in suspension culture containing stem cell factor (SCF). A number of erythroid bursts and mixed erythroid colonies also developed in methylcellulose culture under the same combination. The addition of anti-gp130 monoclonal antibodies but not anti-EPO antibody to the same culture completely abrogated the generation of erythroid cells. These results clearly demonstrate that mature erythroid cells can be emerged from hemopoietic progenitors without EPO in vitro. Together with the previous reports that human sera contain detectable levels of sIL-6R, IL-6, and SCF, current data suggest that gp130 signaling in association with c-kit activation may play a role in human erythropoiesis in vivo.

Characterization of peripheral blood progenitor cells (PBPC) mobilized by filgrastim (rHuG-CSF) in normal volunteers: dose-effect relationship for filgrastim with the character of mobilized PBPC

Filgrastim (rHuG-CSF)-mobilized peripheral blood progenitor cells (PBPC) in healthy Japanese volunteers were characterized in detail using two clonal cell culture systems and double-colour flow cytometry to detect multilineage colony-forming cells and subsets of CD34+ cells. The kinetics of PBPC during the administration of filgrastim was studied, and possible differences in the character of progenitor cells relative to given doses of filgrastim were investigated. Filgrastim was administered subcutaneously to normal volunteers for 7 d at doses of 100, 200 or 400 microgram/m2 (10 per cohort). Treatment with 100 or 200 microgram/m2 filgrastim was well tolerated; however, the 400 microgram/m2 dose level was not completed because of bone pain and myalgia. The treatment strikingly mobilized various types of progenitor cells, including highly proliferative megakaryocytic colony-forming cells. The number of progenitor cells peaked on days 5 and 6. The fold increase of circulating progenitor cells from the baseline value in the volunteers treated with 200 microgram/m2 filgrastim was more pronounced than in those treated with 100 microgram/m2. Treatment with 200 microgram/m2 also released the less mature progenitor cells (i.e. mixed colony-forming cells CD34+/33- cells, and CD34+/HLA-DR-cells) into circulation better than the 100 microgram/m2 dose. These results suggest that daily subcutaneous injection with 200 microgram/m/2 filgrastim for 5 d will effectively mobilize, both qualitatively and quantitatively, PBPC in healthy donors.

Watershed zone in the human peripheral choroid

PURPOSE

To evaluate the angioarchitecture and the hemodynamics in the peripheral choroid in humans.

METHODS

Choroidal circulation was examined in 23 normal eyes and in 7 with equatorial lattice degeneration by wide-angle indocyanine green (ICG) angiography using a scanning laser ophthalmoscope. A hand-held 30-diopter lens was placed in front of the eye to expand the observation angle from the original 40 degrees to 70 degrees. The peripheral temporal choroid and the ora serrata thus could be seen in one frame.

RESULTS

An arterial watershed zone was identified in the temporal peripheral choroid in 21 of 30 eyes. This watershed zone was located in a sectorial region posterior to the ora serrata. It did not form a circular belt along the equator. The area anterior to the watershed zone was supplied by peripheral retrograde choroidal arteries. Inflow of dye into the peripheral retrograde choroidal arteries was consistently later than into the more posterior choroid via short posterior ciliary arteries. The terminal branches of peripheral and short posterior ciliary arteries did not form functional anastomoses. Peripheral retrograde choroidal arteries showed wide variations in number and distribution. These arteries originated from recurrent branches of long posterior ciliary arteries in 18 of 21 eyes and from anterior ciliary arteries in 3 eyes. There was no correlation between the watershed zone and equatorial lattice degeneration in location and extent.

CONCLUSION

A peripheral watershed zone is a regular feature in the far temporal sector of the choroid. The far peripheral choroid anterior to the watershed zone was perfused by peripheral retrograde choroidal arteries which originated from the long posterior ciliary arteries and/or the anterior ciliary arteries.

Remodelling of choroidal circulation in carotid cavernous sinus fistula

BACKGROUND

Carotid cavernous sinus fistula may induce drastic changes in choroidal circulation secondary to elevated orbital venous pressure.

CASES AND METHODS

Three patients affected by spontaneous carotid cavernous sinus fistula were studied for 3-15 months. The angioarchitecture and hemodynamics of the choroid were evaluated repeatedly by indocyanine green angiography using a montage panoramic technique.

RESULTS

Choroidal vessels underwent drastic restructuring including patchy nonperfusion of the choriocapillaris, attenuation of vortex veins, preferential venous dilatations, and drainage into outflow channels near the optic disc or into anterior ciliary veins.

CONCLUSIONS

Choroidal veins were very versatile in remodelling their structure and hemodynamics after sustained elevation of orbital venous pressure. The presence of numerous anastomoses between choroidal veins appeared to be a major underlying cause of this versatility. The observed remodelling of choroidal vessels seemed to be guided by the principle that the venous blood flowed toward sites of lesser pressure resistance.

[Study of choroidal vascular lesions in bullous retinal detachment by indocyanine green angiography]

Fluorescein and indocyanine green (ICG) angiography was performed in 18 eyes of 9 patients with bullous retinal detachment. The series comprised 12 eyes with retinal detachment, 3 treated eyes and 3 unaffected eyes. In the 12 eyes with retinal detachment, there were a total of 33 sites of fluorescein leakage, or 2.8 per eye. Leakage of ICG into the subretinal space, corresponding to the site of leakage of fluorescein, was present at 29 foci in 12 eyes. A dilated major choroidal vein was located posterior or adjacent to the site of leakage. Choroidal tissue staining was present around 30 foci of leakage in 12 eyes in late-phase ICG angiograms. This phenomenon persisted after serous retinal detachment had disappeared following photocoagulation. Multiple areas of choroidal staining were also present in unaffected areas in all the 12 eyes. Choroidal staining was also a regular feature around retinal pigment epithelial detachment. Recurrence of leakage developed in this area in one eye. The findings suggest that choroidal vascular hyperpermeability plays a causative role in damage to the retinal pigment epithelium in bullous retinal detachment.

gp130 and c-Kit signalings synergize for ex vivo expansion of human primitive hemopoietic progenitor cells

gp130, a signal-transducing receptor component of interleukin 6 (IL-6), associates with an IL-6 and IL-6 receptor (IL-6) complex and transduces signals. To examine the role of gp130 signaling in the expansion of human hemopoietic progenitor cells, we tested the effects of a recombinant soluble human IL-6 receptor (sIL-6R) and/or IL-6 in combination with other cytokines on purified human umbilical cord blood CD34+ cells, using methylcellulose clonal assay and suspension culture in the presence or absence of serum. A combination of sIL-6R and IL-6 (sIL-6R/IL-6), but not sIL-6R or IL-6 alone, was found to dramatically stimulate expansion of hemopoietic progenitor cells as well as CD34+ cells in the presence of stem cell factor. Significant generation of multipotential hemopoietic progenitors over a period of 3 weeks in suspension culture and efficient formation of colonies, especially multilineage and blast cell colonies, in methylcellulose assay supplemented with a combination of sIL-6R/IL-6 together with stem cell factor were observed in serum-containing and serum-free culture. Addition of anti-gp130 monoclonal antibodies or anti-IL-6R monoclonal antibodies to the above cultures dose-dependently inhibited the expansion of progenitor cells in suspension culture and also completely blocked the formation of multilineage colonies in methylcellulose culture. These findings demonstrated that the significant expansion of human primitive hemopoietic progenitors could be achieved with the gp130 and c-Kit signalings initiated by the sIL-6R/IL-6 complex in the presence of stem cell factor and suggested the possible application of this method for ex vivo expansion of CD34+ cells for bone marrow transplantation.

Establishment and characterization of a human renal carcinoma cell line MRT-1, with special reference to the production of serine proteinase inhibitors

A new human cell line MRT-1 was established from a metastatic lymph node of renal cell carcinoma of a 47 years old Japanese male. The cultured MRT-1 cells exhibit an epithelial appearance and contain lipid vacuoles in their cytoplasm in vitro. The modal chromosome number was 70. Doubling time and plating efficiency were 32.5 h and 5%, respectively (at the 47th passage). Injection of 1X10(6) MRT-1 cells beneath the renal capsule of nude mice resulted in tumor formation resembling the original tumor. Serine proteinase inhibitors produced by the cell line were analyzed. The cultured cells produced alpha 1-antitrypsin (alpha 1-AT) and plasminogen activator inhibitor-1 (PAl-1) into the conditioned medium. Most of the MRT-1 derived alpha 1-AT had lost the affinity to Concanavalin A when compared to the normal plasma alpha 1-AT.

Prognostic significance of nucleolar organizer regions in hepatocellular carcinoma

It has been suggested that the number of argyrophilic nucleolar organizer regions (AgNORs) correlates with cellular activity and the aggressiveness of malignancy. The mean number of AgNORs per nucleus may, therefore, be a prognostic factor for hepatocellular carcinoma (HCC). The purpose of this study was to evaluate the prognostic significance of the number of AgNORs in HCC. The silver-staining technique was applied to surgically resected specimens to indicate AgNORs. Eighty-nine of the specimens were of HCC, 23 were of normal liver adjacent to HCC, and 32 were of cirrhotic liver adjacent to HCC. The number of AgNORs of HCC (mean +/- SD, 3.26 +/- 1.23) was significantly higher than those of normal liver (1.37 +/- 0.13) and cirrhotic liver (1.49 +/- 0.14). The number of AgNORs was significantly correlated with serum alpha-fetoprotein level, tumor size, portal vein invasion, and Edmondson-Steiner histological grade. In patients undergoing curative resection, the survival rate of those with a high number (> 3.04) of AgNORs was significantly worse than that of those with a low number (< or = 3.04) of AgNORs. Multivariate analysis showed that the number of AgNORs was a significant prognostic indicator in patients without portal vein invasion, and portal vein invasion was the only significant variable when all patients undergoing curative resection were assessed together. The results of this study suggest that the number of AgNORs is useful as an indicator of the grade of malignancy and as a predictor of the prognosis of patients with HCC who do not have portal vein involvement.

Establishment of a new human urinary bladder mixed carcinoma cell line UMK-1 and its cell-density-dependent secretion of gelatinases and tissue inhibitor of metalloproteinase-1

A new human carcinoma cell line, UMK-1, was established from primary urinary bladder carcinoma with histological diagnosis of transitional cell carcinoma grade 2, with squamous and adenocarcinomatous differentiation. These histologic features were maintained in the cultured cells and in xenografted tumors in nude mice. Ultrastructurally, the cultured cells were characterized by formation of glandular structure with well-formed junctional complexes and microvilli, intracytoplasmic lumina and tonofilament bundles. Upon continuous propagation in serum-free medium, UMK-1 cells secreted gelatinases and tissue inhibitor of metalloproteinase (TIMP)-1 into the conditioned medium. The gelatinolytic activities which were inhibited by EDTA, were composed of a major band at 95 kD and a minor band at 68 kD on gelatin zymography. The measurement of TIMP-1 in the conditioned medium was performed by the one-step sandwich enzyme immunoassay system. The production of gelatinases and TIMP-1 was observed during the late log phase of the cell growth and those productions showed similar kinetics. UMK-1 cells can be used to study the interaction of tumor cell-derived gelatinolytic proteinases and TIMP-1 in cancer invasion and metastasis.

Continuous hyperthermic peritoneal perfusion for the prevention of peritoneal recurrence of gastric cancer: randomized controlled study

We performed continuous hyperthermic peritoneal perfusion (CHPP) or continuous normothermic peritoneal perfusion (CNPP) combined with cisplatin (CDDP) 300 mg/kg and mitomycin C (MMC) 30 mg/kg in an attempt to prevent peritoneal recurrence after surgery for gastric cancer. Twenty-two patients were treated with perfusion using about 10 liters of saline heated to 41 degrees to 42 degrees C (CNPP group); 18 patients were treated with saline heated to 37 degrees to 38 degrees C (CNPP group); and 18 patients underwent only gastric surgery without perfusion (control group) in a randomized control study. There were two deaths (9%) due to peritoneal recurrence in the CHPP group, four (22%) in the CNPP group, and four (22%) in the control group. The 1-, 2-, and 3-year survival rates were 95%, 89%, and 68%, in the CHPP group; 81%, 75%, and 51%, in the CNPP group; and 43%, 23%, and 23%, in the control group, respectively. There was a significant difference between the three survival curves by the log-rank test (p < 0.01). This difference showed that CNPP and CHPP are both effective procedures for preventing peritoneal recurrence. The maximum concentrations in the perfusate of total and free CDDP with 300 mg administration were 12.2 and 10.1 micrograms/ml, respectively, at the end of the perfusion, and the maximum concentrations of total and free CDDP in plasma were 2.1 and 1.0 micrograms/ml, respectively. The maximum concentrations of MMC in perfusate and plasma with 30 mg administration were 1.00 and 0.05 micrograms/ml, respectively, which are intraperitoneally cytotoxic but systemically safe concentrations.

Enhanced expression of a tumor-cell-derived collagenase-stimulatory factor in urothelial carcinoma: its usefulness as a tumor marker for bladder cancers

A mouse monoclonal antibody (MAb) E11F4, previously raised against the tumor-cell-derived collagenase-stimulatory factor (TCSF) from LX-1 human lung-carcinoma cells, has been used to define the expression and distribution of TCSF in human non-neoplastic urothelium and tumors of the urinary bladder. Immunohistochemically, TCSF was detected in 27/28 transitional-cell carcinomas (TCC) of the bladder, of which 23 were judged to be positive for TCSF according to objective criteria. Twenty-four of 28 non-neoplastic urothelium from 22 individuals were judged to be negative for TCSF by this criteria. However, TCSF immunostaining that was confined to the superficial umbrella cells was frequently observed in non-neoplastic urothelium. In bladder carcinomas, TCSF was in most cases demonstrated in the majority of cells, including at the invasion front. Its localization to the cell membrane was demonstrated by immunoelectron microscopy. The high level of expression of TCSF in bladder tumors, but not in non-neoplastic urothelium, was also demonstrated by immunoblotting of tissue extracts. Furthermore, E11F4 immunostaining identified tumor cells obtained from bladder washings or voided urine and detected more TCC cases than conventional cytology. Since TCSF immunostaining was positive even in low-grade TCC (immunohistochemically and immunocytochemically in 4/5 TCC grade I), the application of TCSF immunostaining to urine cytology appears promising as a valuable adjunct to conventional methods in the clinical evaluation of patients with TCC.

Possible role of stem cell factor as a serum factor: monoclonal anti-c-kit antibody abrogates interleukin-6-dependent colony growth in serum-containing culture

The monoclonal rat anti-c-kit antibody (ACK2), which abrogates colony growth supported by stem cell factor (SCF), significantly inhibited the interleukin-6 (IL-6)-dependent growth of hematopoietic progenitors derived from spleen cells of normal and 5-fluorouracil (5-FU)-treated mice and from bone marrow cells of normal mice in serum-containing culture. The numbers and types of colonies supported by IL-3, granulocyte-macrophage colony-stimulating factor (GM-CSF) and granulocyte colony-stimulating factor (G-CSF), however, were not influenced by the addition of ACK2 to the cultures of the bone marrow cells from normal mice. In replating experiments with pooled blast cells, ACK2 caused a partial, but significant, inhibition of GM colony growth supported by a combination of IL-6 and fetal bovine serum (FBS), which suggests that FBS is one source of the SCF activity. Conversely, the addition of SCF or FBS with IL-6 to a serum-free culture had significant synergistic effects on the total number of colonies derived from post-5-FU spleen cells and from pooled blast cells. The dose response study showed that the ability of 30% FBS to interact with IL-6 on the colony growth by post-5-FU spleen cells was equivalent to that of approximately 5 ng/mL SCF. These findings suggest that c-kit plays an important role in the growth of hematopoietic progenitors responding to IL-6, and that SCF in the serum affects the development of hematopoietic progenitors in serum-containing cultures.

[A giant esophageal ulcer in a hemophiliac with HIV infection]

A 21-year-old man with hemophilia B and human immunodeficiency virus (HIV) infection was admitted with hematemesis and melena. After admission, esophagogram and endoscopy showed a single giant ulcer with ovoid shape and slightly irregular margins in the middle esophagus. Biopsy specimens of the esophageal ulcer showed non-specific granulation and etiology was unknown. Therapeutic trails of famotidine, sodium alginate, acyclovir, and amphotericin B did not result in favorable response. With a combination therapy of dexamethasone and sucralfate, the swallowing pain was rapidly disappeared with gradual improvement of the ulcer. To our knowledge, this is the first report of a giant esophageal ulcer in a HIV infected patient in Japan.

Generation of tunable coherent extreme-ultraviolet radiation at wavelengths as low as 66 nm by resonant four-wave mixing

Tunable coherent extreme-ultraviolet (XUV) radiation at wavelengths as low as 66.86 nm was generated by two-photon resonant four-wave mixing in a hydrogen molecular gas jet. In this investigation, an ArF excimer laser was tuned to the E,F(1)Sigma(+)(g)(upsilon' = 6)-X(1)Sigma(+)(g)(upsilon' = 0) Q(1) transition of H(2), and the second-harmonic radiation of a dye laser was mixed to obtain the resultant XUV radiation. To our knowledge, this tunable XUV radiation is the shortest wavelength obtained so far by two-photon resonant four-wave mixing.

Significance of different levels of the Edinburgh 2 coma scale calculated from the outcome of neurosurgical patients

In the management of patients with acute cerebral disturbances, it is essential to determine precisely the degree of impaired consciousness. In order to secure the accuracy of observations, one must use a reliable coma scale. We have evaluated the Edinburgh 2 coma scale (E2CS) and explored the relationship between levels of the E2CS and the final outcome. Case notes and observation charts of the past 7 years were reviewed, covering neurosurgical operations on 406 patients, in each of whom the postoperative course was evaluated periodically by the E2CS and the outcome was determined by the Glasgow outcome scale. By matching the outcome with each level of impaired consciousness, about 22,000 pairs of data were obtained. In order to quantify the morbidity rate, different stages of the Glasgow outcome scale were rated from 100 through 0, arbitrarily. It was proved that levels of the E2CS were arranged in the correct order in respect to both mortality and morbidity rates. It was shown at the same time that each level has different prognostic significance and that the distance between each level is not identical. The recommendation is made to separate the levels on a chart not by an ordinal number but by the distance calculated on the basis of either mortality or morbidity rates. This will make it possible to get a rough estimate of the patients' prognoses by simply looking at a daily clinical chart.

[PMUE therapy (CDDP, MMC, UFT, etoposide) for advanced gastric cancer--a case report]

CDDP, MMC, UFT and Etoposide (PMUE)-combined therapy was given to a 62-year-old man with advanced gastric carcinoma. PMUE therapy consists of i.v. injection of CDDP 75 mg/m2 and MMC 10 mg/body on day 1, i.v. injection of Etoposide 50 mg/body on days 3, 4 and 5 and consecutive daily administration of UFT 400 mg/body, with 3 weeks as one course. He was admitted for Borrmann type 3 gastric carcinoma with multiple liver metastasis, lymph node metastases and peritoneal dissemination, the underwent total gastrectomy with R2 lymph node dissection. He was treated four times with this therapy after sensitivity test for carcinostatic agents (SDI test), which resulted in complete remission, as confirmed by CT scan and second-look operation. The patient has currently been free of disease, and we conclude that this PMUE therapy is extremely effective for advanced gastric carcinoma.

Integrated surface acoustic wave deflector and optical disk tracking experiment: development

To improve the access time of the optical disk, we have developed an integrated surface acoustic wave deflector. An end-coupled laser diode with a gradient-index lens, a half-wave plate, and a geodesic waveguide lens are integrated together with surface acoustic wave deflector on a Ti:LiNbO(3) waveguide. Consequently optical disk tracking on a read-only disk is achieved experimentally with this newly developed deflector. Fabrication techniques for geodesic lenses are also described particularly with respect to polishing and waveguide fabrication.

[A case of intracranial multiple nonspecific granulomas related to rheumatic disease: with special reference to magnetic resonance imaging]

We encountered a rare case of a 48-year-old man with intracranial multiple granulomas secondarily caused by rheumatic disease. This was proven surgically after an 11-year course of remissions and deteriorations. In 1980, at the age of 32 years, the patient was first seen at the clinic of Neurology of the University Hospital, complaining of swelling and arthralgia of the joints of the knee, ankle, and wrist and with remittent fever and visual disturbance. The patient was diagnosed as having possible rheumatoid arthritis, and treated with administration of 30mg/day of prednisolone, which greatly improved the symptoms. The administration of 5 to 10mg/day of prednisolone had been continued after discharge from hospital. In 1985, visual acuity of the left eye decreased, and left facial hypesthesia developed. The patient was rehospitalized at the same clinic, and treated with 100mg/day of prednisolone, which again diminished the symptoms. Computed tomography(CT) on admission showed a high density mass with contrast enhancement in the left cavernous region. In addition to the left cavernous mass, a high density mass was detected by CT in the left parietal lobe, in 1987. Visual acuity of the left eye deteriorated in 1989. Because his response to prednisolone had decreased, the visual symptom was treated with gold sodium, which acted effectiveness. Symptoms deteriorated again in 1990. Early in 1991, CT and magnetic resonance imaging showed a new mass at the right frontal lobe, while the mass in the left cavernous region had increased in size. The patient was transferred to the clinic of Neurosurgery for surgical treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Fluorescein fundus angiography with scanning laser ophthalmoscope. Visibility of leukocytes and platelets in perifoveal capillaries

The authors performed fluorescein fundus angiography in 130 eyes using a scanning laser ophthalmoscope (SLO). Capillaries were observed in the perifoveal area in 63 eyes. In these 63 eyes, numerous fluorescent dots were seen flowing through the capillaries. This feature allowed identification of the direction and velocity of blood flow in the retinal capillaries. The distance from 1 dot to the next was widely variable and averaged 100 microM. The velocity of flow was faster in precapillary arterioles, slower in capillaries, and again faster in postcapillary venules. The dots were much more numerous in an eye with leukemia and less numerous in an eye with idiopathic thrombocytopenic purpura. Staining of whole blood from three healthy persons with fluorescein sodium resulted in prompt and intense staining of leukocytes and platelets. These findings indicate that the observed fluorescent dots in perifoveal capillaries correspond to leukocytes and platelets in the circulating blood.