Modulating autoimmune responses to GAD inhibits disease progression and prolongs islet graft survival in diabetes-prone mice

In nonobese diabetic (NOD) mice, beta-cell reactive T-helper type 1 (Th1) responses develop spontaneously and gradually spread, creating a cascade of responses that ultimately destroys the beta-cells. The diversity of the autoreactive T-cell repertoire creates a major obstacle to the development of therapeutics. We show that even in the presence of established Th1 responses, it is possible to induce autoantigen-specific anti-inflammatory Th2 responses. Immune deviation of T-cell responses to the beta-cell autoantigen glutamate decarboxylase (GAD65), induced an active form of self-tolerance that was associated with an inhibition of disease progression in prediabetic mice and prolonged survival of syngeneic islet grafts in diabetic NOD mice. Thus, modulation of autoantigen-specific Th1/Th2 balances may provide a minimally invasive means of downregulating established pathogenic autoimmune responses.

[Quantitative analysis of glucose tolerance tests, responses using fuzzy inference]

The diagnose of diabetes mellitus is generally made by the Glucose Tolerance Test. The data of this test is composed of the blood glucose level and insulin level with 75 g glucose loading dose. The criteria for the diagnosis of diabetes is proposed by WHO. With these criteria, one person whose value of Blood Glucose (BG) is 201 mg/dl is diagnosed as diabetes mellitus and another whose value of BG is 199 is as Impaired Glucose Tolerance. In this paper, we quantitatively analyze the dynamical responses of glucose tolerance tests and propose a new diagnostic system for diabetes using a fuzzy inference.

Simple bone cysts treated by multiple drill-holes. 23 cysts followed 2-10 years

We treated 23 simple bone cysts by the multiple drill-hole method and reviewed them a mean of 5 (2-10) years later. 11 cysts were located in the humerus, 9 in the femur, 2 in the tibia, and 1 in the pubis. The cysts recurred in 15 cases after the initial operation. 12 recurrent cysts were treated with reoperations. At the follow-up, good bone formation with no sign of recurrence was seen in 15 cases. A residual cyst was found in 8 cases, but further treatment was not considered necessary.

Immunohistochemical detection of estrogen and progesterone receptors performed with an antigen-retrieval technique on methacarn-fixed paraffin-embedded breast cancer tissues

Immunohistochemical detection of estrogen and progesterone receptors (ER and PgR, respectively) was performed in 67 cases of Japanese female invasive breast carcinoma on methacarn-fixed paraffin-embedded sections using monoclonal antibodies against ER (1D5) and PgR (10A9) with an antigen-retrieval technique based on microwave exposure in citrate buffer solution. Staining localized in nuclei and specimens containing > or = 20% specifically stained tumor cell nuclei were considered ER- or PgR-positive; the positive rate was 37% (25/67) for ER and 45% (30/67) for PgR. The immunohistochemical (IHC) results were compared with cytosolic receptors obtained from tissue homogenates as measured by dextran-coated charcoal (DCC) assay, in which tumors were considered ER- and/or PgR-positive when receptor concentration was greater than 3 or 5 fmol/mg cytosolic protein, respectively, and agreement between the two methods was 71.6% for ER and 80.6% for PgR. The sensitivity and specificity were 53.5 and 91.7% for ER-IHC, and 77.4 and 83.3% for PgR-IHC, respectively. In relation to age of the patient and stage of the cancer, ER immunoreactivity correlated with patient's age (> or = 55 vs 55, P = 0.032), and proportionally increased with aging (P = 0.0084) using the Kruskal-Wallis statistics. PgR-immunoreactivity correlated with nodal involvement (P = 0.031) by the TNM system. However, no correlations were found between the results of the DCC assay and any of the clinical parameters examined. Thus, immunohistochemical assay may provide valuable information in predicting prognosis and response to endocrine therapy.

Irregularity of the apophysis of the ischial tuberosity evaluated by magnetic resonance imaging

OBJECTIVE

To report the findings of magnetic resonance imaging (MRI) in two cases of apophyseal irregularity of the ischial tuberosity.

PATIENTS AND METHODS

The authors describe the MRI findings for two males who presented with pain of sudden onset in the buttock. Both patients were examined by radiography, MRI and computed tomography, and one underwent bone scanning.

RESULTS

On T1-weighted images, signal intensity was decreased in both the apophysis and the body adjacent to it; however, the signal intensity on T2-weighted images was increased. These findings are consistent with avulsion fracture of the apophysis.

CONCLUSION

The MRI findings in these cases may support the previously suggested hypothesis that apophyseal irregularity with characteristic radiographic changes over time is caused by avulsion fracture of the apophyseal line. The relation between the characteristic radiographic features and the structural changes associated with fracture in this condition is discussed.

[Combination effect of pirarubicin, ifosfamide, and vincristine sulfate in the treatment of advanced synovial sarcoma--report of a case]

Synovial sarcoma with pulmonary metastases appeared to be sensitive to multiagent chemotherapy of Pirarubicin, Ifosfamide, and Vincristine Sulfate. However, this chemotherapy regimen could not be continued because of severe hemorrhagic cystitis due to the toxicity of Ifosfamide. Even in the advanced stage, this multiagent chemotherapy would be useful for the treatment of synovial sarcoma, if hemorrhagic cystitis could be prevented.

Possible cardiac side effects of granisetron, an antiemetic agent, in patients with bone and soft-tissue sarcomas receiving cytotoxic chemotherapy

The cardiac effect of granisetron, a selective 5-hydroxytryptamine3 receptor antagonist, on 12 patients with bone and soft-tissue sarcomas treated by cytotoxic chemotherapy consisting of multiple courses was examined. Of the 12 patients, 4 showed significant electrocardiographical changes, including sinus bradycardia, integral change of P-waves, junctional escape beat, and atrioventricular (AV) block with Wenckebach phenomenon, indicating stimulatory regulation of the vagus nerve. These changes were observed in each patient after several courses of chemotherapy but not in the first course. There was no correlation between the electrocardiographical changes and the chemotherapeutic agents used or the type of tumor present. A patient with osteosarcoma showed persistent bradycardia in three courses, all protocols of which contained high-dose methotrexate. From these findings we conclude that the cardiac responses may be due to stimulated activity of the vagal efferent nerve, which is regulated reflexly by afferent nerve activity suppressed by granisetron. On the other hand, the antiemetic efficacy of granisetron was satisfactory. These results suggest that careful observation of the heart is necessary when granisetron is used, especially for chemotherapy consisting of repeated multiple courses.

[The relationship between genotypes of HLA-DRB1 alleles and progression of bony destruction changes of rheumatoid arthritis]

The relationship between genotypes of HLA-DRB 1 alleles and the progression of bone destruction of RA patients was assessed. The genotypes of the HLA-DRB 1 alleles were determined in 329 Japanese patients with seropositive RNA by polymerase chain reaction and allele-specific oligonucleotide probe techniques. We regarded HLA-DRB 1* 0101, 0401, 0404, 0405, 1001 and 1402 as susceptible alleles of RA and classified the patients into three groups. The s/s group consisted of those with susceptible factors in both of the HLA-DRB 1 alleles. The s/n group was made up of those having one susceptible factor and one non-susceptible factor. The n/n group consisted of those possessing two non-susceptible factors. The grading of radiographic change that was evaluated by Larsen's criteria compared with the genotyped results. In the result, the median years taken to development to grade III, IV and V were significantly shorter in the s/s groups compared with that in the s/n and n/n groups. Thus, genotyping of HLA-DRB 1 can be a useful prognostic market in the progression of bone destruction of RA.

Multiple neurilemmoma in both legs. A case report

A Japanese man, who was 61 years of age, presented with multiple neurilemmoma in both legs which had arisen from different levels of both sciatic nerves. There were no clinical findings relating to von Recklinghausen's disease in the patient or his siblings. Multiple neurilemmoma may be the result of embryonic metameric anomalies. The condition may be distinguished from von Recklinghausen's disease by the distribution of the lesions and genetic analysis.

[Pharmacokinetic study of UFT in cancer patients receiving maintenance dialysis]

Six post-operative cancer patients receiving chronic dialysis (4 colorectal and 2 gastric cancer) were given daily UFT (300 mg/day tid). To determine the clearance of UFT with dialysis, the plasma concentration of tegafur, 5-FU and uracil were measured on the day with dialysis and without dialysis. The plasma concentrations of tegafur at 2 hours after oral administration of UFT showed no difference between the day with dialysis and without dialysis. The concentration of 5-FU on the next day with dialysis was almost same as that of the patients with normal renal function because of the clearance of 5-FU with dialysis, although that on the 2nd day after dialysis was higher than that with dialysis. It was difficult to compare the plasma concentrations of uracil, because they are different in each patient. Therefore, it was considered to be difficult to maintain the suitable plasma concentration of uracil. However, clearance of UFT with dialysis was good and no severe side effect was observed in administration of UFT. These data suggest that UFT can be useful drug for gastrointestinal cancer patients receiving dialysis in a post-operative adjuvant chemotherapy.

Amino acid phosphatase activity of alkaline phosphatase. A possible role of protein phosphatase

Alkaline phosphatase (ALP) hydrolyzed phosvitin and amino acid phosphates demonstrating nonisotropy at different pH. Orthovanadate, a protein phosphatase inhibitor, more specifically inhibited the serine and tyrosine phosphatase activities of ALP than that of threonine phosphatase at concentrations > 0.1 mM or 0.01 mM, respectively. Calyculin A and okadaic acid at increased concentrations increased ALP amino acid phosphatase activity. Bisphosphonates, such as disodium-1-hydroxy-1-aminopropylidine-1,1-diphosphonate (APD) and ethane-1-hydroxy-1,1-diphosphonate (HEBP), at increased concentrations, inhibited ALP amino acid phosphatase activity. These results suggest that ALP may function as a protein phosphatase. In terms of protein kinase inhibitors, N-[2-(methylamino)ethyl]-5-isoquinolinesulfonamide, N-(6-aminoheyxl)-5-chloro-1-naphthalenesulfomide hydrochloride and 4',5,7-trihydroxyisoflavone had little effect on ALP amino acid phosphatase activity. Staurosporine slightly enhanced ALP serine and threonine phosphatase activities at a concentration of 0.1 mM. These results suggest that protein phosphatase activity does not depend on the protein kinase activity of ALP, since duality between the former and the latter is not supported. ALP may function less as a protein kinase than as a protein phosphatase. The coupling mechanism of phosphate dynamics may be regulated indirectly.

Rheumatoid-susceptible alleles of HLA-DRB1 are genetically recessive to non-susceptible alleles in the progression of bone destruction in the wrists and fingers of patients with RA

OBJECTIVE

To assess the relationship between HLA-DRB1 genotypes and the progression of bone destruction in Japanese patients with RA.

METHODS

The HLA-DRB1 alleles were determined by polymerase chain reaction and allele specific oligonucleotide probe techniques in 160 Japanese patients with RA. HLA-DR 0101, 0401, 0404, 0405, 1001 and 1402 were regarded as susceptible alleles of RA according to previous reports. Patients were classified into three groups (S/S, S/N and N/N group), based on the possession of two, one or no susceptible factor. The grading of radio-graphic changes in the wrists and fingers were evaluated by Larsen's criteria. The radiographic grades were first compared with the results of genotyping in the 160 cross sectional cases. A retrospective study was then conducted on a subgroup consisting of 57 cases taken from the 160 cases used for the cross sectional study.

RESULTS

In the scatter diagram of the 160 cross sectional cases expressing the relationship between the stage of bone destruction and duration of RA, the regression line and the 95% confidence intervals separated the S/S group from the S/N and N/N groups in the early phase of development of bone destruction. In the retrospective study on the 57 cases the median years taken to development to stage V in the wrists after the onset of symptoms were 13.1 in the patients in the S/S group, 22.7 in the S/N group and 23.0 in the N/N group. The difference observed between the S/S and S/N group, and between the S/S and N/N group were statistically significant (p < 0.01), but that between the S/N and N/N groups was not. Thus the bone destruction in the wrists and fingers progressed more rapidly in the S/S group than in the S/N and N/N groups; and the rheumatoid susceptible alleles of HLA-DRB1 can be considered to be genetically recessive to the non-susceptible alleles in the progression of bone destructions in the wrists and fingers.

CONCLUSION

Genotyping of HLA-DRB1 can be a useful prognostic marker in the early phase of RA.