Scoliosis and congenital heart disease

STUDY DESIGN

This study analyzed clinical characteristics of scoliosis associated with congenital heart disease. Chest roentgenograms were reviewed to determine frequency, type, onset, and progression of scoliosis associated with congenital heart disease.

OBJECTIVES

To determine which patients with scoliosis and congenital heart disease should be followed-up carefully.

SUMMARY OF BACKGROUND DATA

Although several studies have been reported on scoliosis and congenital heart disease, the etiology of scoliosis in patients with congenital heart disease is still unknown. Furthermore, it has been difficult to determine the progression of scoliosis.

METHODS

Chest roentgenograms of 680 patients who underwent cardiac operations because of congenital heart disease were evaluated.

RESULTS

Seventy-four (10.9%) of these patients had scoliosis of more than 10 degrees, although most of them had mild curves. Scoliosis in patients under 10 years old undergoing cardiac operations was more severe than in those older than 10 years who underwent surgery. Scoliosis associated with congenital heart disease showed no particular features. Patients with patent ductus arteriosus showed left convex, high thoracic scoliosis after surgery.

CONCLUSIONS

The mechanisms of onset of scoliosis in patients with congenital heart disease were not simple and were affected by several factors, including age at operation, side of approach, and type of congenital heart disease.

Experimental scoliosis induced by rib resection in chickens

Factors which affected the severity of scoliosis induced by rib resection were examined. Seventy chickens were divided into a rib transection group and a rib resection group with seven subgroups, according to the number of ribs treated and the age at surgery, and examined radiographically until 20 weeks postoperatively. Rib transection group chickens showed fusion at the transected site and no marked scoliosis. In the rib resection group, the more ribs resected and the younger the age at operation, the more severely the scoliosis developed. Bone regeneration at the resection site made the progression of scoliosis milder. These findings indicate that the age at rib resection, the number of ribs that are operated on, and nonunion of the resected sites play important roles in the progression of scoliosis induced by rib resection.

Counteracting effect of interferon-alpha and -beta on interferon- gamma-induced production of nitric oxide which is suppressive for antibody response

We investigated the nitric oxide (NO)-mediated immunosuppressive activity of macrophages and the regulatory effect of type I (alpha and beta) interferons (IFNs) on IFN-gamma-induced NO production by macrophages. In the sheep red blood cell (SRBC)-specific secondary antibody response in vitro, the addition of macrophages to the culture of primed spleen cells substantially decreased the number of plaque-forming cells. The concentration of nitrite in the culture supernatant showed a positive correlation with the number of macrophages added in a dose- dependent manner, and the addition of NMMA, a potent inhibitor of NO production, resulted in the restoration of of the response. In addition, anti-IFN-gamma antibody abolished the ability of the immune culture supernatant to stimulate macrophages to produce NO. Therefore, the macrophage-dependent immunosuppression was due primarily to NO that was produced by macrophages in response to IFN-gamma derived from responding lymphocytes. The pretreatment of macrophages with IFN-alpha or -beta gave rise to a dramatic reduction of IFN-gamma-mediated NO production. In addition, the suppressive activity of these macrophages was much lower than that of untreated macrophages. These results indicate that type I IFNs can regulate the immune response by modulating IFN-gamma-induced production of immunosuppressive NO.

[Evaluation of gelatin particle agglutination method for detection of Treponema pallidum antibody]

Treponema pallidum hemagglutination (HA) is one of the most frequently used methods for the detection of Treponema pallidum (T. pallidum) antibodies. Recently, an innovative agglutination method using artificial carriers was newly developed, and is now available as a routine method. In order to compare the newly developed particle agglutination (PA) method (FUJIREBIO INC.) with the conventional HA method, T. pallidum antibody titers of numerous sera were measured by respective methods. In the stability study, reconstituted reagent was stable for at least three weeks. Sample inactivation (56 degrees C/30 min) demonstrated no effect on the test results. Among 800 sera, 132 (16.6%) positives (+), 633 (79.1%) negatives (-) and (4.3%) indeterminates (+) were obtained by HA method. Meanwhile, 144 (18.0%) positives (+), 627 (78.4%) negatives (-) and 29 (3.6%) indeterminates (+) were obtained by PA method. The correlation between PA and HA method was 97.8%, and the antibody titers obtained by PA method showed good correlation with HA method. Those samples which showed discrepancy between PA and HA method in the above study were further examined with fluorescent treponemal antibody-absorption (FTA-ABS) method. The results obtained from FTA-ABS method were almost consistent with those obtained from PA method. For respective syphilis patients in stage I and II, antibody titer was monitored by HA, PA and RPR method. The results indicated that changes in antibody titer obtained from PA method was approximately the same as the titer changes obtained from RPR method. Namely, PA method detected the presence of IgM earlier than HA method.(ABSTRACT TRUNCATED AT 250 WORDS)

Cultured murine dermal cells can function like thymic nurse cells

We have established a dermal fibroblast-like stromal cell line, DFB-1, and a clone, 12E2, from epidermal sheets prepared from the skin of BALB/c mouse ears by trypsin digestion. They were suggested to be fibroblasts or myofibroblasts, as 1) they were polygonal or spindle-shaped under the phase-contrast microscope, 2) they did not possess any tonofilaments or desmosomes, and 3) they did not express any marker for bone marrow-derived cells or macrophages. Interestingly, these cells showed a unique phenomenon of "pseudo-emperiporesis," which was first recognized in the interaction between thymic nurse cells and thymocytes. Namely, two T-cell clones and one T-cell hybridoma migrated beneath the cytoplasmic projections of the fibroblast-like cutaneous stromal cells in culture. Furthermore, secretion of interleukin 7 by these cells was confirmed by bioassay using an IL-7-dependent cell line and by inhibition with anti-interleukin 7 antibody, and the expression of interleukin 7 mRNA was also demonstrated in these cells by a combination of reverse-transcriptase polymerase chain reaction and Southern blot analysis. These data strongly suggest the presence of unique stromal cells even in the skin, probably at the upper dermis, which can function like the nurse cells in the thymus. These stromal cells may play a crucial role in cutaneous immunophysiology.

[Experimental acute lung injury in guinea pigs after aerosol challenge with sonicated Pseudomonas aeruginosa whole cells]

Acute hemorrhagic alveolitis was elicited in the lungs of guinea pigs by aerosol challenge with sonicated P. aeruginosa whole cells. Histological findings showed the severe inflammatory changes, which were characterized by the inflammatory infiltration of alveolar macrophages (AM), polymorphonuclear leukocytes (PMN) and eosinophils in the peribronchial and the alveolar space at 8 hours after the challenge. A marked increase of PMN as well as AM was noted in the bronchial alveolar lavage fluid (BALF) at 8 hours after the challenge and the increase of the numbers of AM and PMN in the BALF remained until 24 hours after challenge. The complement titer (CH50) and C3 component in the serum decreased at the early stage, and CH50 maintained low level and C3 component increased gradually. Polyethyleneglycol precipitation-complement consumption test (PEG-CC) of the BALF showed the existence of immune complexes formed in the airway after aerosol inhalation. These data suggest that the immune complexes of P. aeruginosa activate the complement system in the lungs, which is followed by the infiltration of inflammatory cells. Guinea pigs which were pretreated with cobra venom factor significantly reduced the extent of the inflammatory changes in the lungs. The results suggests that the complement system might act as an important factor of the acute lung injury in this model.

[Study of retinal correspondence in esotropia with phase difference haploscope]

There is some concern regarding the evaluated depth of anomalous correspondence, because we often experience paradoxical results. We have already reported that, in intermittent exotropia, we sometimes found dual correspondence with a phase difference haploscope (PDH) reducing the stimulus intensity of either image with a series of neutral density filters. In this study, we analyzed the retinal correspondence in esotropes with the same procedure. 27 esotropes were examined. 11 cases had normal correspondence and 16 cases anomalous correspondence in PDH. All of the 11 normal correspondence cases retained normal correspondence when we reduced the stimulus intensity of either image of fixating eyes or squinting eyes. In the 16 anomalous correspondence cases in PDH, 2 cases showed normal correspondence when the stimulus intensity of the fixating eyes was reduced. On the other hand, 3 cases showed normal correspondence when the stimulus intensity of the squinting eyes was reduced. In fixed heterotropia, both the fovea and the part of the retina of the squinting eye which received the same images as the fovea of the fixating eye (fixating point), were suppressed by the fixating eye. We consider that, in some cases with anomalous retinal correspondence in PDH, when the stimulus intensity of the fixating eyes or the squinting eyes is reduced, the balance of the sensitivity of the foveas and the fixating points of the squinting eyes change, and show normal correspondence.

Granulocytes, macrophages, and dendritic cells arise from a common major histocompatibility complex class II-negative progenitor in mouse bone marrow

The developmental origin of dendritic cells, a specialized system of major histocompatibility complex (MHC) class II-rich antigen-presenting cells for T-cell immunity and tolerance, is not well characterized. Granulocyte-macrophage colony-stimulating factor (GM-CSF) is known to stimulate dendritic cells, including growth and development from MHC class II-negative precursors in suspension cultures of mouse bone marrow. Here we studied colony formation in semi-solid methylcellulose cultures, a classical bioassay system in which GM-CSF induces the formation of mixed granulocyte-macrophage colonies. When colonies were induced from MHC class II-negative precursors, a small subset (1-2%) of typical dendritic cells developed alongside macrophages and granulocytes. The dendritic cells were distinguished by their cytologic features, high levels of MHC class II products, and distinct intracellular granule antigens. By using differential adherence to plastic, enriched populations of the various myeloid cell types were isolated from colonies. Only the dendritic cells stimulated a primary T-cell immune response, the mixed leukocyte reaction, and the potency was comparable to typical dendritic cells isolated from spleen. Macrophages from mixed or pure colonies were inactive as stimulator cells. Therefore, three distinct pathways of myeloid development--granulocytes, macrophages, and dendritic cells--can develop from a common MHC class II-negative progenitor under the aegis of GM-CSF.

Generation of large numbers of dendritic cells from mouse bone marrow cultures supplemented with granulocyte/macrophage colony-stimulating factor

Antigen-presenting, major histocompatibility complex (MHC) class II-rich dendritic cells are known to arise from bone marrow. However, marrow lacks mature dendritic cells, and substantial numbers of proliferating less-mature cells have yet to be identified. The methodology for inducing dendritic cell growth that was recently described for mouse blood now has been modified to MHC class II-negative precursors in marrow. A key step is to remove the majority of nonadherent, newly formed granulocytes by gentle washes during the first 2-4 d of culture. This leaves behind proliferating clusters that are loosely attached to a more firmly adherent "stroma." At days 4-6 the clusters can be dislodged, isolated by 1-g sedimentation, and upon reculture, large numbers of dendritic cells are released. The latter are readily identified on the basis of their distinct cell shape, ultrastructure, and repertoire of antigens, as detected with a panel of monoclonal antibodies. The dendritic cells express high levels of MHC class II products and act as powerful accessory cells for initiating the mixed leukocyte reaction. Neither the clusters nor mature dendritic cells are generated if macrophage colony-stimulating factor rather than granulocyte/macrophage colony-stimulating factor (GM-CSF) is applied. Therefore, GM-CSF generates all three lineages of myeloid cells (granulocytes, macrophages, and dendritic cells). Since > 5 x 10(6) dendritic cells develop in 1 wk from precursors within the large hind limb bones of a single animal, marrow progenitors can act as a major source of dendritic cells. This feature should prove useful for future molecular and clinical studies of this otherwise trace cell type.

[Inhibition of Cls activity by methylprednisolone]

From a clinical study it was found that serum ClINH activity increased 6 hours after methylprednisolone (MP) pulse therapy in all the patients we studied with connective tissue diseases. Furthermore plasma ClINH-Cls complex decreased after pulse therapy. These phenomena lead us to investigate the effect of MP on Cls. 1) When a constant amount of Cls (8 micrograms/ml) was incubated with several concentrations of MP (2-50 mg/ml), the Cls activity of consuming C4 hemolysis was inhibited by MP in a dose-dependent manner. 2) MP inhibited consumption of C2 as well as C4 by Cls in a dose-dependent manner, even when MP had been removed by dialysis following incubation with Cls. These experimental data suggested that the trace amounts of Cls generated by immune complexes could be inhibited by long circulation of MP even at low concentrations in vivo, and resulted in a decrease of ClINH consumption and ClINH-Cls complex formation. These results indicated that the inhibition of Cls activity is one of the most important mechanisms in the process of the anti-inflammatory effect of MP in vivo.

[Complement fragments in patients with bronchial asthma]

In this study, we investigated the pharmacological reactions induced by ibudilast to the complement system with the aim of clarifying the functional relation of the complement system to allergic reactions and pathology in patients with bronchial asthma. Complement hemolytic activities (CH50 and ACH50), complement profile, anaphylatoxins (C3a and C5a) and complement fragments (Bb, iC3b and C4d) were measured in 20 patients with bronchial asthma. One of antiasthmatic activities induced by ibudilast was concluded to be brought about though inactivation of the alternative complement pathway working on type III allergic reaction. Ibudilast increased the complement fragment Bb in the patients' plasma with the fairly controlled bronchial asthma. This increase in circulating Bb was suspected to be a result of inactivation of intermediate complement complexes, for example C3b.Bb.P, because the amounts in plasma of C3 and C5 showed no changes, while those of factor, B, P, H and I were decreased by ibudilast administration in patients with fairly controlled bronchial asthma. This antiasthmatic ability of ibudilast was restrained in those patients whose peripheral leukocytopenia was advanced before ibudilast administration, and in those whom ibudilast did not provoke an increase in the plasma level of iC3b, or did not prevent the serum level of C5 from increasing. In those unfairly controlled cases, enough anaphylatoxins, especially C5a might be produced to make the margination of peripheral neutrophils to the lung and increase CR3 on neutrophils binding with iC3b.

[The relationship between complement C3 receptors (CR1, CR3) on polymorphonuclear leukocytes and complement fragments during hemodialysis]

The expression of complement receptor type 1 (CR1) and type 3 (CR3) on polymorphonuclear leukocytes (PMNs) and generation of complement fragments, C3a, C5a, C4d, iC3b and Bb, were studied in patients during hemodialysis using cuprammonium rayon (Cu) membranes. Furthermore, the relation between the expression of CR1 and CR3 on PMNs from healthy donors and complement fragments was investigated. The expression of CR1 and CR3 on PMNs increased during hemodialysis. Plasma C3a, C5a and iC3b levels increased in the first 15 minutes and then decreased at 120 minutes of dialysis. But plasma Bb level remained high until the end of hemodialysis. Purified Bb had no effect on the expression of CR1 and CR3 on PMNs, but C5a augmented those expression in vitro. Nafamostat mesilate, an artificial proteinase inhibitor, inhibited augmentation of complement receptors on PMNs in concentration dependent fashion. C5a generated through the activation of complement was thought to take an important role in the increased expression of CR1 and CR3 on PMNs.

A comparative trial of the reactogenicity and immunogenicity of Takeda acellular pertussis vaccine combined with tetanus and diphtheria toxoids. Outcome in 3- to 8-month-old infants, 9- to 23-month-old infants and children, and 24- to 30-month-old children

The reactogenicity and immunogenicity of the Takeda acellular pertussis vaccine combined with tetanus and diphtheria toxoids were compared in 139 infants aged 3 to 8 months, 60 infants and children aged 9 to 23 months, and 99 children aged 24 to 30 months. Good antibody responses to pertussis toxin (PT), filamentous hemagglutinin (FHA), and agglutinogens occurred in all age groups after both the third and fourth doses. After the fourth (booster) dose, the mean antibody values in initially seronegative infants vaccinated at 3 to 8 months of age were as follows: anti-PT, 67.8 enzyme-linked immunosorbent assay units (EU) per milliliter; anti-FHA, 149.5 EU/mL; the agglutinin titer was 125.6. The values in initially seronegative children vaccinated at 24 to 30 months of age were as follows: anti-PT, 92.9 EU/mL; anti-FHA, 251.7 EU/mL; the agglutinin titer was 275.8. Reactions following immunization were minimal. Except for drowsiness after the first dose in infants, there were no clinically significant differences in reactions between infants and older children. The findings in this study coupled with the recent demonstration of efficacy of this vaccine in 2-year-old children supports the recent Japanese recommendation to lower the age of immunization with acellular pertussis vaccine combined with tetanus and diphtheria toxoids to 3 months.

[Kinetics of immune complex deposition and influence of decomplementation on their clearance in cationized antigen induced acute serum sickness]

Using a murine acute serum sickness model caused by cationized bovine gamma-globulin (CBGG), the histological findings, accumulation of CBGG in the organs and the effect of decomplementation for the clearance of immune complex (IC) were investigated. The accumulation of CBGG increased in the lungs in the presence of anti-CBGG antibody 1 hour after injection of CBGG, but did not change in the kidneys. This suggests that CBGG forms IC in situ in the kidneys, and that circulating IC accumulates in the lungs. Decomplementation did not influence the uptake of CBGG immediately after challenge but delayed the clearance of CBGG in the kidneys, lungs, liver and spleen. A beneficial role of the complement system in the clearance of IC even for those formed in situ was recognized. Histological changes, cellular infiltration and microvascular destruction, evoked in the lungs in this experimental model immediately after challenge, were not seen in the kidney, suggesting the different modes of complement activation in these organs.

[A simplified method for the assessment of C1 esterase inhibitor function]

From the result that the activated form of C1-s(C1-s) prolonged the kinetics of hemolysis via complement, this assay was applied to assess C1 esterase inhibitor (C1INH) function. In the kinetic assay, the complement hemolytic activity was evaluated by the time which required to cause 50% reduction of the initial turbidity of sensitized sheep erythrocytes, and was expressed as T1/2. (1) T1/2 of pooled normal human sera (p-NHS) showed dose-dependent prolongation by the addition of various amounts of C1-s. (2) Preincubation of various amounts of functionally pure C1INH with the constant amounts of C1-s inhibited dose-dependently the prolongation of T1/2 by C1-s. (3) The C1INH activity of NHS was 840 +/- 80 units/ml (n = 6) and that of the C1INH deficient serum was 80 units/ml, which were calculated from the standard curve established by the addition of various amounts of purified C1INH. This test requiring only C1-s and sensitized sheep erythrocytes is simple technically and high in sensitivity, and seems to be useful for the routine assay for C1INH function of human sera.

Removal of immunosuppressive substance in cancer patients' serum

Anemia-inducing substance (AIS) appears in plasma as cancer progresses. In this study, a non-coated charcoal column was used to remove AIS from the cachectic plasma obtained from patients with advanced cancer. AIS could be completely removed by 6 cycles of adsorption using this column. Similar data were obtained in an experiment using VX-2-transplanted rabbits. These observations raised the possibility that plasmapheresis with a non-coated charcoal column may be available as a new means of immunotherapy for advanced cancer.

[Plasma levels of complement fragments during hemodialysis in patients with chronic renal failure]

The kinetics of hemodialysis-induced leukopenia and generation of complement fragments including C3a, C5a, C4d, iC3b and Bb were investigated in 14 patients during hemodialysis using cellulose acetate (CA), cuprophan (Cu) and ethylenevinyl alcohol (EVA) membranes. A marked leukopenia in the first 15 minutes was observed in CA and Cu. Plasma C3a levels were higher in CA than in Cu and EVA. Plasma C5a levels were higher in CA and Cu than in EVA. There was a negative correlation between the white blood cell counts and plasma C5a levels at 15 minutes (gamma = -0.85, p less than 0.001). Plasma C4d levels showed no increase in all membranes. Plasma iC3b levels were higher significantly in Cu than in CA and EVA. Plasma Bb levels in the first 15 minutes increased significantly in all membranes, and furthermore continued to increase till the end of hemodialysis in CA and Cu. This study revealed that all the membranes tested activated the complement via the alternative pathway to produce Bb, iC3b, C3a and C5a. C5a was thought to take an important role in transient leukopenia. Furthermore, Bb was accumulated during hemodialysis in CA and Cu, and its biological effects on patients undergoing hemodialysis should be studied.

[Pregnancy induced hypertension (PIH) and osteoporosis]

The authors have already reported that the bone density of normal pregnant women might be kept at the same density as in normal non-pregnant women. However, it might be decreased in women with pregnancy induced hypertension (PIH) by estimating serum calcium levels, serum levels of calcium regulating hormones and calcium secretion into the urine. In order to demonstrate this theory, the degree of bone density in the second metacarpal bone of normal or PIH pregnant women was measured by X-ray using microdensitometry method (MD method). In MD method, six indices, such as MCI, d, GSmin, GSmax, sigma GS/D and densitometric pattern, are calculated by computer analysis of the X-ray of the bilateral hands. By the evaluation of the degree of bone atrophy, scores such as 0 better than the regression line of healthy women, which were prepared according to each age, 1 until 1 delta to the aggravation, 2 until 2 delta, and 3 more than 2 delta were totaled and evaluated as normal, initial stage of bone atrophy, 1st degree of bone atrophy, 2nd degree of bone atrophy and 3rd degree of bone atrophy for 0-3 scores, 4-9 scores, 10-12 scores and 13-18 scores, respectively (delta = 1 S.D.). The metacarpal index (MCI) of normal pregnant women in 3rd trimester was more than the mean in all cases, while cases more than 2 delta of the mean were noted in 29.4% of mild PIH and 11.8% of severe PIH, and a decreasing tendency of width of bone cortex was considered in PIH women. On the other hand, width of bone marrow (d) increased significantly in mild and severe PIH women. In the index for the density of only bone cortex area (GSmax) in PIH women, cases less than mean -1 delta were noted in 29.3% of mild types and in 11.8% of severe types respectively, and a high incidence was noted even though it was insignificant compared with 7.4% of normal pregnant women. In the index of the densities of bone cortex and bone marrow (GSmin), cases less than mean -1 delta were noted more frequently in PIH women than normal pregnant women, but in the index of bone density per unit length (sigma GS/D) no differences were noted between PIH and normal pregnant women.(ABSTRACT TRUNCATED AT 400 WORDS)

[Changes of complement in immune complex glomerulonephritis induced by cationized antigen]

Complement system takes an important role in the pathogenesis of immune complex glomerulonephritis. In this study the precise changes of serum complement and its deposition in the glomeruli were investigated in the mice models induced with cationized bovine gamma-globulin (CBGG). Balb/c mice preimmunized with CBGG were injected intravenously with CBGG three times every 24 hours. Proteinuria and hypoalbuminemia have developed from day 3 until the death on day 9-13 of progressed azotemia. This nephritis resembled to mesangial proliferative glomerulonephritis histopathologically. Immunofluorescent study revealed granular deposits of CBGG, IgG, A, M and C3 along the glomerular capillary loop. Serum C3 decreased to about 50% of normal controls within 1 hour after challenge of antigen and plasma C3 conversion evaluated by crossed-immunoelectrophoresis, occurred in accordance with C3 reduction and then decreased. Immunofluorescent study showed a big difference in the mode of deposition among IgG, CBGG and C3. The most intense deposits of C3 in the glomeruli were seen 12 hours after challenge of CBGG, and then gradually decreased until the next challenge. IgG and CBGG antigen deposited most intensely soon after the challenge of antigen, and gradually decreased. These results led us to conclude that there existed two phases of complement activation in this immune complex induced mice glomerulonephritis; an early phase activation of complement by antigen-antibody complexes in the circulation and later phase activation of complement by immune complexes after deposition of them in situ glomeruli.

Specific [125I]Bolton-Hunter substance P binding sites in human and rat skin

[125I]Bolton-Hunter substance P [( 125I]BH-SP) binding sites in rat and human skin were investigated, using quantitative receptor autoradiographic and emulsion autoradiographic methods. [125I]BH-SP binding sites were discretely localized in skin areas anatomically corresponding to dermal papillae, sweat glands, and hair follicles. The highest density of the binding sites was in the dermal papilla of the finger, followed by the sweat gland. [125I]BH-SP binding to the dermal papillae of the human finger pad skin and rat paw pad skin was displaced by unlabeled SP, with a high affinity, and Kd values were calculated to be 744 pM and 297 pM, respectively. The existence of [125I]BH-SP binding sites supports the idea of the neurotransmitter role of substance P in skin dermal papilla.

[A study on bone density in women during pregnancy and postpartum]

Although 25-30 grams of calcium is transported into the fetus during pregnancy, it is suggested that the maternal bone might be kept at the same density as in non-pregnant women by measuring serum or urinary calcium concentrations and calcium regulating hormones simultaneously (Ohara et al. Folia Endocrinol., 1986). In this study, the influence of pregnancy on the maternal bone was investigated by measuring the degree of bone density in the second metacarpal bone of pregnant or puerperal women in an X-ray picture using a microdensitometer and a computer (Microdensitometry method; MD method, Inoue et al., 1983). Among six indices provided by this method, d (bone marrow width) tended to increase, but MCI (Barnett's metacarpal index) tended to decrease toward late pregnancy. GSmin, GSmax and sigma GS/D were significantly lower in the third trimester of pregnancy than in the second trimester of pregnancy. The densitometric patterns were A in most of the pregnant and puerperal women, but one case with the pattern of AB and two cases with the pattern of B were found in the third trimester of pregnancy. The sum of the scores of the six indices, which were based on the severity of each index, was within 0-3 in pregnant or puerperal women though it tended to increase as pregnancy progressed. From these results, it was confirmed that maternal bone density was maintained within the normal limits throughout pregnancy and postpartum.

[Studies on the dynamics of insulin secretion and the regulatory mechanism of insulin receptor in fetal rats]

In order to clarify the onset of insulin secretion and the regulatory mechanism of its receptor induction in fetus, blood glucose, serum insulin and its hepatic receptor in situ in fetal rats (D18-D21) were measured and the changes of the levels of insulin and its receptor after the direct injection of glucose (1g/kg) to fetal rats in utero were investigated. In fetal rats (D18-D21), both serum insulin and glucose levels increased as pregnancy progresses and specific binding of insulin in fetal liver microsomal membranes increased on D21 of gestation, mainly due to the increase in binding affinity rather than binding capacity. After the direct injection of glucose to the fetus in utero, the rapid increase in serum insulin and the rapid decrease in insulin specific binding to liver microsomal membranes were observed in a part of D20 and all of D21 fetal rats, which was mainly due to the decrease of binding capacity. This suggests that the acute elevation of endogenous insulin level followed by the decrease of insulin specific binding in fetal rat liver is based on the down regulation mechanism of insulin receptor, because the amounts of insulin separated from liver microsomal membranes were less than one twentieth of the insulin concentration which are enough to decrease the binding capacity of hepatic receptor theoretically. In addition, the dissociation of 125I-insulin from liver microsomal membranes of glucose-treated rats were indistinguishable from that of control. From these results, it can be concluded that the onset of glucose-stimulated insulin secretion appears in fetal rats on D20 of gestation and the elevation of endogeneous insulin rapidly down-regulates the number of hepatic insulin receptor in fetal rats.

Anemia-inducing substance (AIS) in advanced cancer: inhibitory effect of AIS on the function of erythrocytes and immunocompetent cells

The effects of anemia-inducing substance (AIS), found in the plasma of tumor-bearing subjects, on red blood cells (RBC) and cellular immunity were examined. The results obtained may be summarized as follows: 1) The osmotic resistance and the deformability of RBC were decreased in patients with terminal cancer. 2) Normal human RBC were made less deformable and their membrane was made fragile by treatment with cachectic plasma from those patients, and these changes in physical properties were irreversible. 3) Energy metabolism in RBC was affected by AIS, that is, ATP concentration and pyruvate kinase activity in RBC were lowered and transmembrane glucose influx was suppressed. 4) AIS was removed from cachectic plasma by repeated adsorption with normal RBC, and the inhibitory effect on cellular immunity was lessened as AIS was removed. 5) AIS was detected in cachectic RBC membrane, monocytes, and tumor tissue by indirect immunofluorescence assay using rabbit anti-AIS antibody prepared by us. These observations suggest strongly that tumor-derived AIS appears in the blood of patients with terminal cancer, shows cytotoxicity to RBC and immunologically competent cells, and plays a role in the pathogenesis of cancer cachexy.

Mechanism of killing of Giardia lamblia trophozoites by complement

Only antibodies of the IgM class support the lytic effect of complement on Giardia lamblia (GL). We sensitized GL trophozoites (SGL) at 4 degrees C with serum containing anti-GL antibodies or IgM purified from this serum, and either normal human serum (NHS), complement 2-deficient human serum (C2d-HS), or C4-deficient guinea pig serum was used as source of complement. SGL were killed by NHS (86%) and by the deficient sera (50 and 40%, respectively), suggesting activation of the alternative pathway. However, the reaction was inhibited by Mg-EGTA. These observations led to studies of the role of C1. The lytic effect of NHS and C2d-HS on SGL was abolished by immunochemically depleting C1 from these sera, and reconstituted by adding purified C1q plus C1r and C1s. Factor B-depleted C2d-HS also lost its capacity to mediate killing, but reconstitution with factor B led to a dose-dependent increase in the killing of SGL. We next investigated the participation of the membrane attack complex in this system. SGL carrying C5b to C7 were lysed when incubated with C8 alone (56%); the addition of C9 further increased killing (98%), while C9 in the absence of C8 had no effect. We concluded that although activation of the classical pathway produces lysis of SGL, lysis may also proceed through a unique pathway of complement activation that requires C1 and factor B, but is independent of C4 and C2. Lysis of SGL can be accomplished by C5b to C8 in the absence of C9.

[Insulin receptors in fat tissue of human and rat during pregnancy]

Insulin receptors in fat cell membranes (10(5)g pellets) were investigated by a conventional incubation method in pregnant and nonpregnant rats or women. Insulin binding in pregnant L20 rats was 8.1 +/- 2.1% (M +/- SD) less than that in nonpregnant rats (14.5 +/- 3.5%) in peripheral adipose tissues (p less than 0.05). In the former a reciprocal rise in the serum insulin level was observed. In pregnant women, insulin binding was determined in subcutaneous fat tissues obtained at cesarean section or other laparotomy. Insulin binding was 29.3 +/- 8.9% in nonpregnant women, and it did not change in early pregnancy (34.3 +/- 6.2%, NS). However, it decreased obviously in late pregnancy (20.4 +/- 6.4%) (p less than 0.05). Scatchard analysis indicated that the decrease in insulin binding was due to the changes in the number of insulin receptors in fat cell membranes. Their Kd values were indistinguishable from each other in rats and women. In addition, insulin binding correlated significantly with Insulin Sum, Glucose Sum at 75g OGTT, TG and FFA in serum. These results suggested that insulin receptors in adipose tissues were suppressed in late pregnancy, and this might be the cause of the "insulin resistance" observed in the maternal body in late pregnancy.

[Insulin receptors in pregnant nonobese diabetic (NOD) mice]

The dynamics of insulin receptors was investigated in the feto-placenta-maternal system of DM-onset pregnant nonobese diabetic (NOD) mice. Insulin binding experiments were carried out by conventional incubation methods using cell membrane fractions (10(5) X g pellets). The results were as follows. In the case of JCL-ICR mice, used as the control, insulin specific binding in liver cell membranes, which was 26.6 +/- 3.2% in the nonpregnant state, decreased in late pregnancy (20.7 +/- 2.7%). On the other hand, in pregnant NOD mice hepatic insulin binding was 24.3 +/- 1.0%, more than that of JCL-ICR pregnant mice. By Scatchard analyses, these changes were found to be due to the changes in the number of receptors especially in high affinity sites. The serum insulin level was 6.3 +/- 4.2 microU/ml in pregnant NOD mice, which was much lower than that in other mice (nonpregnant JCL-ICR: 14.8 +/- 6.4, pregnant JCL-ICR: 37.3 +/- 18.3). In fetal liver and carcasses of NOD fetuses, insulin binding was also much greater than that in JCL-ICR fetuses. In conclusion, the hormone sensitivity to insulin was accentuated in pregnant DM-onset NOD mice not only in the maternal body but also in the fetus. This is regarded as a metabolic adaptation to the environment in the insulin deficient state of these mice. And it is speculated that insulin receptors are also down-regulated in fetal liver as well as in adult mice.

Studies on the ontogenesis and the regulatory mechanisms of placental lactogen and insulin binding sites (receptor) in rat liver

The ontogenesis of specific binding of 125I-hPL and 125I-insulin was determined in rat liver cell membranes (10(5) X g pellets), and the regulatory mechanisms of these binding sites were also examined. There were striking differences in the mode of ontogenesis between binding sites of hPL and insulin in rats. HPL binding sites were very few in liver cell membranes from fetal and immature rats. They began to increase after puberty, and markedly increased in late pregnancy. On the other hand, insulin binding sites, which decreased in late pregnancy, were dominant in fetal liver and placenta. Consequently, the lipolytic and glycogenolytic activities of hPL in maternal liver were accentuated, whereas the effects of insulin on maternal liver were suppressed. In contrast, in fetal liver and placenta only the anabolic effects of insulin seemed conspicuous. According to the results of experiments on in vivo administration of estradiol-17 beta, progesterone, hydrocortisone or hPL to intact or hypox-rats, and the measurement of serum rat chorionic mammotropin (rCM), rPRL, estradiol-17 beta, and insulin during pregnancy in rats, the increase in hepatic hPL binding sites observed in late pregnancy might be, at least in part, due to rCM secreted from placenta, and the decrease in insulin binding sites due to the increase in serum insulin itself in rats.(ABSTRACT TRUNCATED AT 250 WORDS)

C3b receptor (CR1) on erythrocytes in various diseases

Complement receptor for C3b (CR1) on erythrocytes was investigated in various diseases by immune adherence hemagglutination (IAHA) using aggregated human IgG. In normal controls, 21 out of 312 (6%) revealed defective CR1 reactivity, and there was no difference in the prevalence of defective CR1 reactivity between female (11/157, 7%) and male (10/155, 6%). Among diseases examined significantly high prevalence of defective reactivity of CR1 on erythrocytes was seen in systemic lupus erythematosus (SLE) (22/30, 73%) and malignancy of hematopoietic system, especially in acute myelogenous leukemia (AML)(6/11, 55%).

[Effect of human chorionic somatomammotropin on release of glucose by perfused rat liver (author's transl)]

The biological action of hCS was studied in non-recirculating perfusion system of the pregnant rat liver. A modified method of Mortimore and of Millor for the liver perfusion was used. The perfusate was prepared with Krebs-Ringer bicarbonate buffer with the addition of BSA (2%), glucose (10 mM) and human erythrocytes (Ht. 12%). The results were as follows. 1) The biological condition of the liver remained good during 90 minutes of perfusion as judged by its gross appearance, O2 consumption, CO2 production, bile secretion and the levels of transaminase, K+, pH in effluent and the microscopic observation after the perfusion. 2) An addition of hCS (20 micrograms/ml) to the perfused pregnant liver resulted in a momentary increase of glucose, FFA and K+ concentration in the effluent. 3) The elevation of the glucose level was also observed after the repeated administration of hCS. This release of glucose from perfused liver after hCS administration took, place more rapidly with the progress of the pregnancy. 4) The elevation of glucose level was maintained longer by the continuous administration of hCS (10 micrograms/ml). 5) Hepatic glycogen decreased after the continuous administration of hCS, but it increased in the control group. The level of cyclic-AMP in the perfused liver rose after the continuous administration of hCS.

Simultaneous presence of EBNA-positive and colony-forming cells in peripheral blood of patients with infectious mononucleosis

EBNA-positive lymphoblast cells were detected in 0.1 to 0.9% of the T-cell-depleted lymphocytes obtained from peripheral blood samples of five patients with infectious mononucleosis (IM). The same blood specimens from four of the five patients contained cells that formed EBNA-positive colonies in soft agar containing EBV antibodies. The ratio of the colony formers to EBNA-positive cells was higher in blood samples taken early in the disease than in those obtained in later stages of the disease. The present results strongly suggest that EBV-transformed cells are present in the peripheral circulation of IM patients and that such cells can directly give rise to immortalized cell lines in vitro.

A study on the effect of dehydroepiandrosterone sulfate on so-called cervical ripening

Dehydroepiandrosterone sulfate (DHAS) is now used for a dynamic test of placental function by many obstetricians. While practicing this test, the authors found that DHAS markedly promoted so-called "cervical ripening". To study this problem, DHAS of 50 or 100 mg in multiple doses were injected into 132 Japanese pregnant women in their 38th--42nd week of gestation. The change in Bishop score was carefully recorded. Bishop score in the injected groups of primiparae (100 mg) began to rise much sooner than the control groups (p less than 0.01 on seventh day and 14th day). However, such significant difference in the rise of Bishop score was not noted in the multiparae and primiparae with 50 mg. Although the rise of score is not significant, the duration (day) from injection to delivery was shorter in the injected group than the control group (t=2.1529, p less than 0.05 in primiparae with 50 mg, t=3.8829, p less than 0.01 with 100 mg, t=2.1029, p less than 0.05 in multiparae with 50 mg). In some of these cases, labor began or delivery was finished within 24 hrs. Among the factors of Bishop score, mainly the effacement, consistency and dilatation of the cervix were remarkably improved by DHAS injection (p less than 0.01 and less than 0.05). Side effects of any type were not seen in the mothers and foetuses. As a conclusion, DHAS injection in considered to produce favorable conditions for delivery in women with "unripe cervix" by softening the soft birth canal. Furthermore, it is suggested that DHAS might play an important role in triggering labor.