Interleukin-4-independent production of Th2 cytokines by nasal lymphocytes and nasal eosinophilia in murine allergic rhinitis

BACKGROUND

Interleukin (IL)-4 is believed to play an important role in the atopic pathogenesis. However, the precise role of IL-4 in the in vivo initiation of allergic rhinitis is not fully understood. We have recently found that BALB/c mice sensitized intranasally with Schistosoma mansoni egg antigen (SEA) mount a Th2 response that initiates allergic rhinitis. Thus, we sought to determine the role of IL-4 in the initiation of allergic rhinitis in vivo with this model.

METHODS

IL-4 gene-deficient (IL-4 -/-) BALB/c and wild-type (IL-4 +/+) control mice were sensitized by intranasal SEA administration, and their immunologic responses were examined both in vivo and in vitro.

RESULTS

IL-4 +/+ mice sensitized with SEA displayed significantly higher titers of SEA-specific IgG1 and IgE antibodies than IL-4-/- mice, while the latter produced significantly more SEA-specific IgG2a. Antigen-stimulated nasal lymphocytes from SEA-sensitized IL-4 -/- and IL-4 +/+ mice produced similar amounts of IL-5 and IL-10, but neither produced IFN-gamma. Furthermore, the severity of nasal eosinophilia was similar in both groups.

CONCLUSIONS

These results indicate that although IL-4 is necessary for the production of Th2-associated antibodies--in particular, IgE--it is not required for either the production of the Th2-associated cytokines IL-5 and IL-10, or the induction of nasal eosinophilia.

Liposarcoma of the tongue: case report and literature update

Liposarcoma is an exceedingly rare tumor in the oral cavity. We report a case of a 70-year-old man with liposarcoma that presented as a lump on the tongue. The excised tumor was diagnosed as a well-differentiated lipoma-like liposarcoma. The majority of cases of well-differentiated liposarcoma follow a relatively benign course, but the disease has a high recurrence rate. It appears that accurate clinical and histopathologic diagnosis of this lesion is difficult. The prognosis seems to depend on the histologic type, size, and location of the lesion. Wide surgical excision is important for successful management of these liposarcomas.

Genomic structure of the human ING1 gene and tumor-specific mutations detected in head and neck squamous cell carcinomas

We characterized the genomic structure of the human ING1 gene, a candidate tumor suppressor gene, and found that the gene has three exons. We also demonstrated that four mRNA variants were transcribed from three different promoter regions. Of 34 informative cases of head and neck squamous cell carcinoma, 68% of tumors showed loss of heterozygosity at chromosome 13q33-34, where the ING1 gene is located. Here we present the first report that three missense mutations and three silent changes were detected in the ING1 gene in 6 of 23 tumors with allelic loss at the 13q33-34 region. These missense mutations were found within the PHD finger domain and nuclear localization motif in ING1 protein, probably abrogating the normal function.

The perineuronal proteoglycan surface coat in the adult rat brain, with special reference to its reactions to Gömöri's ammoniacal silver

The present study showed that many neurons in the adult rat brain possessed a perineuronal sulfated proteoglycan surface coat which reacted to cationic iron colloid and aldehyde fuchsin. This surface coat was stained supravitally with Ehrlich's methylene blue and doubly stained with Ehrlich's methylene blue and aldehyde fuchsin. The surface coat was also stained with Gömöri's ammoniacal silver and doubly stained with Gömöri's ammoniacal silver and cationic iron colloid. The surface coat was usually expressed together with a nerve cell surface glycoprotein net detectable with lectin Wisteria floribunda agglutinin. These findings indicate that the perineuronal proteoglycan surface coat is identical to Cajal's superficial reticulum and contains some collagenous elements. It was further demonstrated that collagenase digestion erased Gömöri's ammoniacal silver impregnation within the perineuronal proteoglycan surface coat.

Necrosis of the tongue after transient ischemic attack

We report an unusual case of necrosis of the tongue after transient ischemic attack in a 67-year-old man. Angiography revealed occlusion of the right external carotid artery at the bifurcation of the common carotid artery. Debridement of the wound and removal of the necrotic tissue resulted in good healing.

Induction of Th2 responses and IgE is largely due to carbohydrates functioning as adjuvants on Schistosoma mansoni egg antigens

Infection with the helminth parasite Schistosoma mansoni induces a pronounced Th2-type response that is associated with significant IgE production. To better understand how the parasite drives these responses, we investigated the relative roles of proteins and carbohydrates in driving Th2-type and/or IgE responses using a murine model of intranasal sensitization with soluble egg Ags (SEA) of Schistosoma mansoni. We found that repeated intranasal sensitization with soluble egg Ags led to the induction of both total and specific IgE production and nasal eosinophilia. By comparing the responses of mice sensitized with SEA or metaperiodate-treated SEA we were able to demonstrate that carbohydrates on SEA are the major inducers of IgE production and nasal recruitment of eosinophils. Mice sensitized with periodate-treated SEA displayed a significant decrease in both total and specific IgE levels in comparison to mice sensitized with native SEA. Furthermore, sensitization of mice with periodate-treated SEA significantly reduced levels of Ag-specific IgG1, but had no effect on IgG2a production. Nasal lymphocytes from mice sensitized with native SEA, but not with periodate-treated SEA, produced IL-4, IL-5, and IL-10 when restimulated with native SEA in vitro. On the other hand, lymphocytes from mice sensitized with periodate-treated SEA did not produce any of these same cytokines following in vitro restimulation, suggesting that carbohydrates were required for in vivo induction of Th2 response and for that of associated cytokine responses in this model. Lastly, competitive inhibition ELISA showed that although carbohydrates are required for SEA-specific IgE induction, they are not targets of the induced IgE response.

Cutaneous lymphocyte antigen is expressed on memory/effector B cells in the peripheral blood and monocytoid B cells in the lymphoid tissues

Cutaneous lymphocyte antigen (CLA) is expressed on a subpopulation of human memory T cells and is involved in the primary step of their skin homing. T cells and some B cells in the peripheral blood express CLA, but the pathophysiologic roles of CLA(+) B cells have not yet been clarified. We examined the relationships among CLA expression in B cells and immunoglobulin heavy chain subtype, the localization of CLA(+) B cells in the peripheral lymphoid tissues, and their functional binding to E-selectin. CLA was expressed on class-switched, memory B cells in the peripheral blood and tonsils as revealed by flow cytometry. Immunohistochemical staining of the lymph nodes with various types of inflammation or reactive hyperplasia showed CLA on the monocytoid B cells, which correspond to memory cells. The functional study revealed that CLA on B cells bound to E-selectin transfectants. E-selectin was detected on some of the high endothelial venules in the monocytoid B-cell-rich lymph nodes. These findings suggest that CLA is also expressed on a subset of memory/effector B cells, in addition to a subset of memory T cells. Such B cells were located in the lymph nodes or tonsils and rarely in chronic dermatitis. Therefore, CLA seems to be related to memory/effector B-cell trafficking to the lymph nodes or tonsils. According to the multistep theory, mechanisms involved in the second or third step might be different between CLA(+) B and T cells.

Prevalence and prediction of allergic rhinitis using questionnaire and nasal smear examination in schoolchildren

Allergic rhinitis is a common condition among schoolchildren. However, little is known about the prevalence of nasal eosinophilia. We investigated the prevalence of rhinitis via questionnaire and nasal smears for eosinophils. The questionnaire was administered in 1992 and 1995. Complete responses were obtained from 1044 and 431 schoolchildren, respectively, of whom 26.5% and 22.5% claimed to have nasal symptoms. Nasal smears were taken in 1992, 1993 and 1994, and 415, 285 and 384 samples were collected, respectively. Positive eosinophilia were seen in 39.8%, 35.1% and 35.9% children in 1992, 1993 and 1994, respectively. In 1992, we utilized both questionnaire and nasal smears simultaneously to evaluate 415 schoolchildren. Of 415 schoolchildren, 72 (17.3%) had both nasal symptoms and nasal eosinophilia. Interestingly, those who showed positive eosinophilia in 1992, especially those who had eosinophilia with nasal symptoms, had significantly higher incidence of nasal symptoms three years later in 1995 than those who showed negative eosinophilia in 1992. These results suggest that nasal eosinophilia in schoolchildren are associated with subsequent nasal symptoms, and that nasal smear examination may be a potentially valuable test to predict prolonged or recurrent allergic rhinitis.

The alteration of penicillin-binding proteins (PBPs) in drug-resistant Streptococcus pneumoniae isolated from acute otitis media

Streptococcus pneumoniae is the micro-organism most frequently isolated from acute otitis media (AOM). Recently, drug-resistant or insensitive strains have been prevalent among pneumococcal AOM cases and were reportedly associated with persistent or recurrent otitis media. The purpose of this study was to examine the alterations of penicillin-binding proteins (PBPs) in Streptococcus pneumoniae isolated from AOM. The PBP samples from 21 clinically isolated strains were examined by 14C-penicillin binding assay and also by adding CCL and CDTR as competitors of 14C-penicillin. Reduced signals in PBP1A and PBP2X/2A were typically observed with the penicillin-resistant Streptococcus pneumoniae samples, while widely different PBP profiles were obtained in each strain of penicillin-insensitive Streptococcus pneumoniae. The competitive binding assay with penicillin-insensitive strains revealed the reduced affinity of CCL to PBPs in comparison with that of CDTR. The results of the penicillin-binding assay were consistent with the results from minimal inhibitory concentration analysis, and its potential usefulness for the prediction of drug resistance was demonstrated.

Comparison of tumor markers in patients with squamous cell carcinoma of the head and neck

The serum concentrations of three separate tumor markers, squamous cell carcinoma antigen (SCC Ag), carcinoembryonic antigen (CEA) and Cyfra 21-1 were clinically correlated in 86 randomly selected patients with squamous cell carcinoma involving the head and neck. Positive findings for each tumor marker were totalled and statistically analysed. The upper limits of normal for SCC Ag, CEA and Cyfra 21-1 were set at 1.5, 2.5 and 2.0 ng/ml, respectively. Positivity rates were 20.6% for SCC Ag, 14.0% for CEA and 41.7% for Cyfra 21-1. Elevated Cyfra 21-1 concentrations correlated somewhat with age, whereas elevated CEA levels correlated with the site of tumor involvement. Overall, Cyfra 21-1 appeared to be the most useful marker in head and neck squamous cell carcinoma.

Hearing immaturity found by ABR and its clinical impact on otoneurological evaluation

Auditory Brainstem Response (ABR) is the most reliable and most frequently used procedure to evaluate audiological conditions in early infancy. However, several reports have demonstrated that developmental change in the central nervous system may affect the results of ABR in audiological evaluations. We examined statistically the reliability of ABR for the diagnosis of profound deafness in early childhood according to our experience over the past 12 years of follow-up in our facility. Subjects included 371 children among 1,041 children who were admitted to Kanariya-Gakuen (institute for pre-school deaf children) from April 1985 to March 1997. These children were examined with ABR to determine their hearing levels. In five cases with an abnormal hearing threshold determined by ABR and other audiological tests, repeated examinations carried out during a 5- to 6-month follow-up period revealed that they had normal hearing. Three of these children had been diagnosed previously with mental retardation and the remaining two were infants < 5 months old. The specificity and sensitivity of ABR were calculated as 97.3% and 100%, respectively. The predictive value of a positive result was 94.7%. There remains the possibility of a false negative for such cases, although the rate seems to be very low (< 0.2%).

Calbindin and calmodulin localization in the developing vestibular organ of the musk shrew (Suncus murinus)

The distribution of the Ca(2+)-binding proteins, calbindin and calmodulin, in the adult inner ear has been described previously. We undertook immunohistochemical investigation of developmental changes in the distribution of calbindin and calmodulin in the vestibular organ of the musk shrew (Suncus murinus). Expression of calbindin was seen first in the hair cells and the vestibular ganglion on gestational day (GD) 19, in nerve fibres on GD23 and in the otoconia on GD26. On GD19 calmodulin was demonstrable only in the hair cells. On GD26 both Ca(2+)-binding proteins showed a distribution of immunoreactivity in hair cells similar to that seen in adults. The developmental differences in distribution of these binding proteins may suggest different roles in the vestibule. Additionally, Ca(2+)-binding proteins may be a useful index of hair cell maturity.

Volume quantification of healthy paranasal cavity by three-dimensional CT imaging

The volume of the air cavities in the paranasal sinuses is, even at present, not only the simplest but also the most important index employed in the evaluation of the paranasal sinus. We have measured the size of the paranasal cavities in 20 healthy Japanese subjects by reconstructing three-dimensional (3-D) computed tomography (CT) images. To avoid any bias in determining the cavity margin, we first measured bilateral maxillary sinuses of a macaque both by silicone injection and by 3-D reconstruction. Then the CT value for 3-D reconstruction was determined by comparison with the volume measured by direct injection. Each sinus of the healthy volunteers was then measured by 3-D reconstruction imaging. Paranasal sinuses were, individually and on the whole, apparently larger than previously reported: 90.1 ml in males and 72.5 ml in females, on average. Comparing with other body size indices, the increment of the size was quite apparent and the lower prevalence of sinusitis was assumed to play a role in this increased volume of paranasal sinuses in the modern Japanese population.

4-methylcatechol, a potent inducer of nerve growth factor synthesis, protects spiral ganglion neurons from aminoglycoside ototoxicity--preliminary report

The degeneration of spiral ganglion neurons after hair cell destruction following aminoglycoside ototoxicity is associated not only with the direct effect on the neurons, but also with a loss of neurotrophic factors provided by auditory hair cells. The neurotrophic factors, including nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF) and neurotrophin-3 (NT-3), have been reported to be effective in enhancing neuronal survival against aminoglycoside ototoxicity in vivo. To determine whether 4-methylcatechol (4-MC), a potent inducer of nerve growth factor synthesis, can protect spiral ganglion neurons after aminoglycoside treatment in vivo, we studied the spiral ganglion neurons of gentamicin (GM)-treated mice with or without 4-MC administration. We found that the number of surviving spiral ganglion neurons of 4-MC-treated animals was significantly greater than for those treated with GM alone. Our results suggest that 4-MC promotes synthesis of NGF (and/or other neurotrophins), which enhances spiral ganglion neuron survival after gentamicin treatment.

Cochlear implantation for symptomatic hereditary deafness

Recently, the effectiveness of cochlear implantation for hereditary deafness has been reported. We performed cochlear implantation for two patients with symptomatic hereditary deafness. Deafness in one patient was thought to be a result of albinism-deafness syndrome and in the other patient, a result of chronic progressive external ophthalmoplegia syndrome. Since their speech perception abilities improved dramatically, we believe that cochlear implantation should be actively performed for these two syndromes.

Does TUNEL staining during peri- and post-natal development of the mouse inner ear indicate apoptosis?

Terminal deoxyribonucleotidyl transferase (TDT)-mediated dUTP-digoxigenin nick end labelling (TUNEL) is being used more frequently to investigate programmed cell death (PCD). We have applied this method in order to examine how PCD is involved in the development of the mouse inner ear. In a series of studies, we identified a population of TUNEL-positive cells in the perinatal mouse ear that could not be regarded as apoptosis based upon morphological features of the nuclei. Theoretically, TUNEL detects DNA fragmentation, which can also occur in necrosis. Other authors regard TUNEL-positive cells in the sensory epithelia of the rat equilibrium organs between gestational day (GD) 19 and 7 days after birth (DAB) as apoptosis. We determined whether or not cells in the inner ear of perinatal and post-natal mice were TUNEL-positive due to apoptosis. We stained the inner ears of BALB/c mice aged GD17.5-4 weeks by the TUNEL method and analysed morphology by light microscopy and transmission electron microscopy (TEM). TUNEL-positive cells were distinct in the saccule from DAB3, and in the cochlea from DAB8. The number of TUNEL-positive cells in the hair cells of the saccule and in the cochlea increased with age, and seemed to reach a plateau just before 2 weeks of age. However, morphological analyses did not reveal findings characteristic of apoptosis. We conclude that these TUNEL-positive cells were labelled not because of apoptosis, but due to necrosis or post-mortem autolysis. We surmise that TUNEL staining can identify vulnerable cells of the inner ear that consume high levels of oxygen and easily undergo autolysis.

Surgical management and its post-operative complications in congenital aural atresia

The post-operative complications and hearing results of surgical intervention for congenital aural atresia were investigated. Seventy-five ears with congenital aural atresia were operated on for hearing loss from 1982 to 1996. Tympanoplasty was performed on 37 ears and canaloplasty on the remaining 38. Hearing improvement rates were 70.3% and 31.6%, respectively. The post-operative complications included stenosis of the created auditory canal (29.3%), deterioration of the improved hearing (21.3%) and infection (12.0%). Reoperations were performed on 6 cases for restoring hearing, 16 for stenosis and 6 for infection. Reoperative findings demonstrated that scar formation in the canal caused the stenosis of the newly formed external canal and that lateralization of the new tympanic membrane and subsequent detachment from the ossicles caused the deterioration of improved hearing. Using cartilage and pedicled skin flap prevented stenosis at the orifice of the newly formed external canal. Maintaining hearing improvement requires creating a wide ear canal using as many pedicle flaps as possible and attaching a new tympanic membrane firmly to the ossicles.

Involvement of carbohydrate on phospholipase A2, a bee-venom allergen, in in vivo antigen-specific IgE synthesis in mice

BACKGROUND

Carbohydrates on allergens are known to be important for allergenicity. However, most findings have been made with epitope analysis. In this study, we investigated the involvement of N-glycan on phospholipase A2 (PLA2), the major allergen of honeybee venom, in in vivo synthesis of specific IgE in mice.

METHODS

CBA/J and C57BL/6 mice were sensitized intranasally with either native or deglycosylated PLA2 in the absence of adjuvant. After repeated sensitization, serum Ab titers against PLA2 were determined. PLA2 was deglycosylated chemically with anhydrous trifluoromethanesulfonic acid (TFMS).

RESULTS

CBA/J mice showed PLA2-specific IgE production after repeated sensitization with native PLA2. They also produced PLA2-specific IgG1 predominantly, suggesting that Th2-type Ab production was induced. When we used deglycosylated PLA2 as a competitor in ELISA for detecting PLA2-specific IgE, deglycosylated PLA2 completely inhibited the binding between native PLA2 and IgE. Deglycosylated PLA2 had the same potential for inducing specific IgE synthesis as native PLA2, since sensitization with deglycosylated PLA2 also elicited IgE production in CBA/J mice.

CONCLUSIONS

These results suggest that carbohydrate on PLA2 is less important than previously thought not only as a dominant IgE epitope but also in synthesis of PLA2-specific IgE in vivo.

CD80 (B7-1) and CD86 (B7-2) antigens on house dust mite-specific T cells in atopic disease function through T-T cell interactions

BACKGROUND

CD80 (B7-1) and CD86 (B7-2) play an important role in antigen presentation to effector cells. Recent studies have demonstrated that these costimulatory molecules are also expressed on activated T cells. However, the functional role of CD80 and CD86 expressed on allergen-specific T cells in atopic diseases has not yet been clarified.

OBJECTIVE

We sought to determine the functional role of CD80 and CD86 expressed on allergen-specific T cells in atopic diseases.

METHODS

We assayed the expression of CD80 and CD86 on allergen-specific T-cell lines from patients with perennial allergic rhinitis stimulated by Dermatophagoides farinae-crude (Der f-c) antigen, 1 of the major allergens causing house dust mite allergy. T-cell proliferation induced by Der f-c-specific T-T cell interactions was measured, and the role of CD80 and CD86 in this proliferation was examined. In addition, we compared the proportion of CD45RO+CD86(+) T cells in primary culture of PBMCs stimulated by Der f-c antigen between patients with perennial allergic rhinitis and control subjects.

RESULTS

On T-cell activation, CD86 antigen was upregulated earlier than CD80. Both CD80 and CD86 expressed on Der f-c-specific T cells could provide costimulatory signals to induce allergen-specific T-cell proliferation that was partially inhibitable by both anti-CD80 and anti-CD86 mAbs. The proportion of CD45RO+CD86(+) T cells in primary culture from atopic patients was significantly higher than that from control subjects.

CONCLUSION

These results suggest that costimulatory molecules, such as CD80 and CD86, expressed on allergen-specific T cells may be involved in the amplification of allergen-specific immune responses through T-T cell interactions in atopic diseases.

A gene for fluctuating, progressive autosomal dominant nonsyndromic hearing loss, DFNA16, maps to chromosome 2q23-24.3

The sixteenth gene to cause autosomal dominant nonsyndromic hearing loss (ADNSHL), DFNA16, maps to chromosome 2q23-24.3 and is tightly linked to markers in the D2S2380-D2S335 interval. DFNA16 is unique in that it results in the only form of ADNSHL in which the phenotype includes rapidly progressing and fluctuating hearing loss that appears to respond to steroid therapy. This observation suggests that it may be possible to stabilize hearing through medical intervention, once the biophysiology of deafness due to DFNA16 is clarified. Especially intriguing is the localization of several voltage-gated sodium-channel genes to the DFNA16 interval. These cationic channels are excellent positional and functional DFNA16 candidate genes.

Strain-dependent induction of allergic rhinitis without adjuvant in mice

BACKGROUND

To date, no murine models have been reported to show the induction of both antigen-specific IgE and nasal eosinophilia, two of the major hallmarks of allergic rhinitis, after local sensitization in the absence of adjuvants, a phenomenon which reflects natural exposure. In this report, we attempted to establish a murine model representing an initiation of allergic rhinitis.

METHODS

BALB/c, CBA/J, and C57BL/6 mice were sensitized intranasally to Schistosoma mansoni egg antigen (SEA) solely. After repeated sensitization, serum Ab titers, nasal eosinophilia, and cytokine production by nasal lymphocytes were determined.

RESULTS

BALB/c mice produced SEA-specific IgE after repeated sensitization. High-dose sensitization to SEA induced IgE production in CBA/J mice, while C57BL/6 mice did not show the production throughout the period observed, suggesting that IgE production was regulated genetically. BALB/c mice also exhibited nasal eosinophilia after the nasal challenge. In addition, nasal lymphocytes sensitized with SEA intranasally produced significant amount of IL-5 in vitro.

CONCLUSIONS

These results suggest that intranasal sensitization with SEA in the absence of adjuvants induces a Th2 immune reaction, reflecting the hallmarks of the initiation of allergic rhinitis both in vivo and in vitro, which is genetically regulated.

Quantitative analysis of interleukin 6 (IL-6) in patients with IgA nephropathy after tonsillectomy

The biological response to tonsillectomy was studied in 21 patients suffering from chronic tonsillitis with or without IgA nephropathy (IgAN). Serum and urinary interleukin-6 (IL-6) levels were measured before and after tonsillectomy. Serum IL-6 levels in case of IgAN peaked 3 h after tonsillectomy and more rapidly than control cases. No significant differences were observed between two cases through the time. Urinary IL-6 levels were significantly higher before and at 6 and 48 h after tonsillectomy in IgAN cases. Stimulation of tonsils caused serum IL-6 elevation and changes in urinary IL-6 levels in IgAN cases. Elevation of urinary IL-6 levels after tonsillectomy in patients with IgAN may reflect an increase in the production of IL-6 in the kidneys. Measurement of urinary IL-6 levels after tonsillectomy is useful to elucidate the efficacy of tonsillectomy in IgAN patients.

TUNEL staining of inner ear structures may reflect autolysis, not apoptosis

A recent study (Usami et al., 1997) using the TUNEL method has suggested that age-related cell death in the senescence-accelerated mouse inner ear is due to apoptosis. TUNEL staining detects not only apoptosis but also late necrosis or autolysis because it detects DNA breaks. Autolysis may occur in inner ear structures during fixation. To determine whether or not age-related cell death is due to apoptosis, TUNEL staining of the inner ear of normal mice should be understood. However, studies of TUNEL staining of the normal inner ear have not yet been reported. We investigated whether the fixation method or the interval between the death of normal mice and the initiation of fixation influences the results of TUNEL staining of the inner ear. Marginal cells of the stria vascularis and hair cells of the saccule were TUNEL-positive, irrespective of the fixation method or the interval between death and fixation. Interdental cells, Reissner membrane cells, fibrocytes in the suprastrial region, and inner and outer hair cells were also occasionally stained. Transmission electron microscopy showed no morphological characteristics of apoptosis in the hair cells of the saccule. Moreover, patterns of TUNEL staining in the normal and senescence-accelerated mouse inner ear were similar. These stained tissues may require a high level of oxygen, making them more susceptible to autolysis. We concluded that the results of TUNEL staining in the inner ear require confirmation by morphological studies.

[Results of a survey of the relationship between palatine tonsil and IgA nephropathy]

To investigate the relationship between palatine tonsil and IgA nephropathy, a survey was performed by questionnaire to 154 non-ENT medical doctors who had reported case of IgA nephropathy. The questionnaire was sent in February 1997, and answers were obtained within one month from 93 doctors (79 internal physicians, 12 pediatricians and 2 pathologists); a 60.4% response rate. A total of 72.0% of doctors answered that renal pathology was the most important prognostic factor for IgA nephropathy. A total of 73.1% of doctors thought that the administration of corticosteroid was the most effective therapy for IgA nephropathy, whereas only one doctor answered that tonsillectomy was most effective. Urine protein was the most useful factor for the estimation of the treatment, according to 37.6% of doctors. The majority of doctors who replied to the questionnaire thought that palatine tonsil seemed to be involved in the pathophysiology of IgA nephropathy in less than half of patients with IgA nephropathy. In addition, they answered that the rate of patients with IgA nephropathy to whom tonsillectomy was effective was also less than 50%. The tonsillar provocation test was rarely performed for the diagnosis of tonsillar focal infection in IgA nephropathy. Furthermore, 51.6% doctors answered that urine protein was the most important factor in any estimation of the provocation test.