Activated peripheral blood mononuclear cells detected in lupus patients using cDNA coding for proliferating cell nuclear antigen

Abstract The expression of proliferating cell nuclear antigen (PCNA) mRNA in peripheral blood mononuclear cells (PBMCs) from patients with systemic lupus erythematosus (SLE) was measured by dot blot hybridization using a PCNA cDNA, and correlated with the percentage of PCNA-positive cells detected immunohistochemically using a monoclonal anti-PCNA antibody. PCNA-positive PBMCs were detected in 72.2% of SLE patients (n = 36), which is significantly more than among healthy controls. In addition, among those in whom PCNA expression was detected, the percentage of PBMCs expressing PCNA was significantly higher in SLE patients (mean 2.5% vs. 0.15%). The level of PCNA mRNA was increased in PBMCs from 83.3% of SLE patients, and was significantly correlated with the percentage of PCNA-positive cells (r = 0.54, P < 0.01) and with the disease activity score (r = 0.56, P < 0.01). A longitudinal study of two SLE patients confirmed that PCNA mRNA expression and the percentages of PCNA-positive cells varied in parallel with disease activity. Thus, an analysis of activated PBMCs from SLE patients using PCNA cDNA may be a useful method by which to estimate SLE disease activity.

Flocculation properties of pectin in various suspensions

Pectin had a flocculating activity and its flocculating activities in various suspensions were investigated. Flocculating activity of pectin in a kaolin suspension was markedly stimulated by the addition of Al3+ and Fe3+ to the suspension. Optimum temperature for flocculating activity of pectin in the kaolin suspension was around 30 degrees C and high flocculating activity was obtained when 30 mg/l of pectin and 0.2 mM Fe3+ were added to the suspension. Other inorganic suspensions of activated carbon and acid clay were flocculated by pectin in the presence of Al3+ or Fe3+. Flocculation of organic suspensions such as cellulose and yeast by pectin occurred when 0.1-0.2 mM Fe3+ was present in the suspensions.

Anti-Ki antibodies recognize an epitope homologous with SV40 nuclear localization signal: clinical significance and reactivities in various immunoassays

Abstract We studied the characteristics of anti-Ki antibodies that react with a synthetic peptide (KILT) which has homology with SV40 large T antigen nuclear localization signal (SV40 T NLS). Immunoreactivity of antibodies to KILT was tested by enzyme-linked immunosorbent assay (ELISA), and this reactivity was compared with results obtained by immunoblotting using purified Ki and ELISA using purified or recombinant Ki antigen. The clinical significance of anti-KILT antibodies in lupus patients was also studied. Twenty percent of anti-Ki sera reacted with KILT, and all sera that reacted with KILT recognized both purified and recombinant Ki antigen in all our assay systems. A significant correlation was observed between reactivities in ELISA using KILT and with these using purified and recombinant Ki. Some sera with low titers by double immunodiffusion (DID) reacted with KILT, whereas high-titer anti-Ki sera showed a tendency to react with Ki antigen in different assays. The prevalence of discoid rash and sicca complex was higher in the anti-KILT-positive group. The amino acid sequence homologous to SV40 T NLS is an immunologically active epitope on the Ki antigen; reactivity to this epitope is associated with characteristic clinical features allied with anti-Ki antibodies in lupus patients.

Serum levels of interleukin 15 in patients with rheumatic diseases

OBJECTIVE

The role of the cytokine interleukin 15 (IL-15) in rheumatic disease is unclear. We examined serum levels of IL-15 in patients with various rheumatic diseases.

METHODS

Serum levels of IL-15 were determined by sandwich ELISA.

RESULTS

Serum levels of IL-15 were significantly increased in patients with polymyositis/dermatomyositis, polyarteritis nodosa, and systemic sclerosis; and significantly increased as well in disease complicated by interstitial pneumonitis (IP), hemophagocytic syndrome (HPS), and/or vasculitis. Patients with serum IL-15 levels < or = 5 pg/ml showed significantly high rates of survival.

CONCLUSION

IL-15 is related to the pathogenesis of IP, HPS, and/or vasculitis. Serum IL-15 level could possibly be used as a marker of prognosis.

Transient right phrenic nerve palsy associated with central venous catheterization

An 85-yr-old woman with advanced sigmoid colon cancer developed right phrenic nerve palsy following central venous catheterization for preoperative nutritional and fluid balance improvement. The central venous catheter was successfully placed via the left subclavian vein at the first attempt. Blood returned freely through the catheter. The chest x-ray film taken immediately after the catheterization showed the proper placement of the catheter, but it revealed a significant right hemidiaphragmatic elevation indicating phrenic nerve palsy. A chest computed tomography scan and bronchoscopy were normal. As the patient did not complain of dyspnoea and vital signs were normal, tumour resection was performed. The operative and postoperative course was uneventful. The chest x-ray film after the surgery still showed the elevation of the right hemidiaphragm. It resolved completely within 3 days of withdrawing the central venous catheter by 3 cm on the fourth postoperative day. We concluded the likely cause of the phrenic nerve palsy was that the catheter tip impinged upon the thin venous wall and compressed the phrenic nerve running alongside the superior vena cava.

[Therapeutic plasmapheresis for the prevention of congenital complete heart block associated with anti-SS-A/Ro antibody and anti-SS-B/La antibody]

OBJECTIVES

Neonatal lupus erythematosus is characterized by transient lupus abnormalities, various systemic and hematological abnormalities, and congenital complete heart block (CCHB). It is well known that anti-SS-A/Ro antibody (52 kD/60 kD) and anti-SS-B/La antibody are associated with CCHB. This study was conducted to evaluate the effects of the removal of anti-SS-A/Ro antibody (52 kD/60 kD) and anti-SS-B/La antibody from plasma in pregnant women whose fetuses are at a high risk of developing CCHB.

MATERIALS & METHODS

Fifteen pregnant patients positive for anti-SS-A/Ro antibody and anti-SS-B/Laantibody were subjected weekly to double filtration plasmapheresis to remove both antibodies. Antibody titers were measured by double immunodiffusion (DID) and ELISA.

RESULTS

As a result, all women gave birth to live babies, but CCHB was recognized in one baby. No transient lupus abnormalities were recognized in any of the babies. Fourteen patients showed decreased antibody titers by ELISA during plasmapheresis. However, the patient who was delivered of a baby with CCHB showed an increase of antibody titers by ELISA while the DID method showed a decrease of antibody titers.

CONCLUSION

Our study suggested that plasmapheresis prevents CCHB associated with anti-SS-A/Ro and anti-SS-B/La antibody. Also, it is important to monitor the antibody titer regularly during the course of pregnancy, because it may increase due to worsening of the mother's primary disease.

[A clinical study of the usefulness of assessing dyspnea in healthy elderly subjects]

Dyspnea is a major clinical symptom of various respiratory diseases. However, no objective assessment of dyspnea on exertion (DOE) in elderly subjects has been established yet. Furthermore, the factors which may influence DOE in healthy elderly subjects have not yet been precisely elucidated. An oxygen cost diagram (OCD), which was originally developed by McGavin (1978), is one of the methods of assessing dyspnea on exertion in a semi-quantitative way, although it is still uncertain which factor (s) might influence the changes in OCD values. The present study was, therefore, undertaken to study; 1) whether OCD values are useful for the assessment of DOE in elderly subjects, and 2) the possible factors (s) which might contribute to changes in OCD values in these patients. The total number of subjects which were enrolled in the present study was 818, consisting of 355 men and 463 women, whose mean age was 76.4 years old, was studied. Spirometry, arterial blood gases and OCD values were measured on the same day. The OCD value and FEV(1.0) declined linearly with advanced aging. It was found that the factors which significantly reduce OCD values were as follows: aging, vital capacity, FEV(1.0), and maximal voluntary ventilation (MVV). The odd ratio which contributes to changes in OCD values was calculated. It appeared that there was a gender difference: when the odd ratio of OCD values of less than 70 was taken as 1 in the men, the odd ratio in women was calculated as 1.42. The odd ratio increased with advancing age; when the value in the 65~69 year-old group was 1, the odd ratios in the 85~89 year-old and 90~94 year-old groups were in approximately 6 and 8, respectively. Similarly, the odd ratio increased parallel with reduction in MVV. From these results, we conclude that the OCD value is reliable, simple and the best method of evaluating dyspnea in elderly subjects semi-quantitatively, and both the minute ventilatory volume and age are closely related with changes in OCD values.

Reactivity of anti-proliferating cell nuclear antigen (PCNA) murine monoclonal antibodies and human autoantibodies to the PCNA multiprotein complexes involved in cell proliferation

Proliferating cell nuclear Ag (PCNA) occurs as a component of multiprotein complexes during cell proliferation. We found the complexes to react with murine anti-PCNA mAbs, but not with anti-PCNA Abs in lupus sera. The complexes were purified from rabbit thymus extract by affinity chromatography using anti-PCNA mAbs (TOB7, TO17, and TO30) and analyzed by ELISA, immunoprecipitation, immunoblotting, and HPLC gel filtration. That PCNA was complexed with other proteins was demonstrated by its copurification with a group of proteins excluded by an HPLC G3000 SW column. Although immunoblot analysis showed the mAbs to react exclusively with the 34-kDa PCNA polypeptide, they nonetheless immunoprecipitated the same group of proteins, confirming the interaction of the isolated PCNA with other proteins. Anti-PCNA sera, including AK, which reacts with biologically functional sites on PCNA, did not react with complexed PCNA, but did react with it once it was dissociated from the complexes. PCNA complexes in turn reacted with murine anti-DNA mAbs, as well as with Abs against p21, replication protein A, DNA helicase II, cyclin-dependent kinases 4 and 5, and topoisomerase I. These findings suggest that the PCNA complexes purified using anti-PCNA mAbs comprise the "protein machinery" for DNA replication and cell cycle regulation. They also suggest that anti-PCNA mAbs are useful tools with which to characterize the protein-protein interactions within PCNA complexes, as well as the autoimmune responses to proteins interacting with PCNA, which may shed light on the mechanisms of autoantibody production in lupus patients.

Purification and characterization of mannose isomerase from Agrobacterium radiobacter M-1

A mannose isomerase from Agrobacterium radiobacter M-1 (formerly Pseudomonas sp. MI) was purified to electrophoretic homogeneity and characterized. A cell-free extract was separated by ammonium sulfate fractionation, Butyl-Toyopearl 650M, DEAE-Sepharose and hydroxylapatite column chromatography. Its molecular mass was estimated to be 44 kDa by SDS-PAGE and 90 kDa by gel filtration, in which the enzyme is most likely a dimer composed of two identical subunits. The purified enzyme had an optimum pH at 8.0, an optimum temperature at 60 degrees C, a pI of 5.2 and a Km of 20 mM, and specifically converted D-mannose and D-lyxose to ketose. The N-terminal amino acid sequence was identified.

Phosphorylation of vimentin head domain inhibits interaction with the carboxyl-terminal end of alpha-helical rod domain studied by surface plasmon resonance measurements

The amino-terminal head domain of vimentin is the target site for several protein kinases and phosphorylation induces disassembly of the vimentin intermediate filaments in vivo and in vitro. To better understand molecular mechanisms involved in phosphorylation-dependent disassembly, we examined domain interactions involving the head domain and the effect of phosphorylation on the interaction, using surface plasmon resonance. We observed that the head domain binds to the carboxyl-terminal helix 2B in the rod domain, under physiological ionic strength. This interaction was interfered with by A-kinase phosphorylation of the head domain. Deletion of the carboxyl-terminal 20 amino acids of helix 2B resulted in loss of the interaction. Furthermore, peptide representing the carboxyl-terminal 20 residues of helix 2B had a substantial affinity with the head domain but not with the phosphorylated one. These findings support the idea that the interaction between the head domain and the last 20 residues of helix 2B is essential for association of vimentin tetramers into the intermediate filaments and that the phosphorylation-dependent disassembly is the result of loss of the interaction.

Effect of immune complexes in serum from patients with rheumatoid vasculitis on the expression of cell adhesion molecules on polymorphonuclear cells

OBJECTIVE

Immune complexes (IC) are frequently detected in patients with rheumatoid vasculitis (RV). To explore the pathogenic role of IC in the development of vasculitis among patients with rheumatoid arthritis (RA), we examined the effect of IC on the expression of cell adhesion molecules (CAM) on polymorphonuclear cells (PMN).

METHODS

PMN from healthy volunteers were incubated with the sera from 26 patients with RA including 9 patients with RV, and the expression of CAM on the PMN was assessed by flow cytometry.

RESULTS

We found that 67% (6/9) of the serum samples from RV patients and 18% (3/17) of the samples from RA patients without RV revealed up-regulated CD11b expression. On the other hand, 89% (8/9) of the samples from RV patients and 12% (2/17) of the samples from RA patients without RV revealed up-regulated CD18 expression. However, the expression of CD11a was not affected. Up-regulation of CD11b and CD18 on PMN was also induced by the immunoglobulin G (IgG) fraction of the sera of RV patients. Moreover, L-selectin expression on PMN was down-regulated by the sera or IgG of some patients with RV. These changes in CAM expression on PMN induced by IgG of RV patients were not observed when PMN were incubated with the IgG of RV patients from which the IC formed by IgG had been removed.

CONCLUSION

These results suggest that IC formed by IgG in patients with RA are involved in the development of vasculitis by affecting the expression of CAM on PMN.

[Objective evaluation of treatment for sleep apnea syndrome]

CPAP treatments for sleep apnea syndrome (SAS) are being established; however, there is no established evaluation method to scale the long-lasting effectiveness of the treatment. The only available method is to judge the results from each patient's subjective symptoms. We therefore tested a self-contained microcomputer with an acceleration sensor (Lifecorder) in an attempt to evaluate the effectiveness of treatments objectively. Fifteen patients with OSAS were the subjects. We keep the records of Lifecorders that were worn by the subjects a month before and a month after nasal CPAP treatment. We also assessed their daily physical activity levels; the number of steps taken, calories consumed, intensity of each activity along with improvement in their subjective symptoms. The number of steps taken in a day increased as did the calories consumed after treatment in 9 subjects. Moderate and intensive activities also increased among those 9 subjects. Our results indicate that evaluation with a Lifecorder, which is simple and inexpensive, can provide objective indicators to assess the effectiveness of treatments in patients' daily activities.

[Polysomnography]

Polysomnography(PSG) is essential for the diagnosis of all pathophysiologic conditions due to both any types of sleep disordered breathing and to any types of sleep disturbance. Since this issue's objection is to describe the outline of PSG, we will explain here about when PSG is needed, what type of measurements are necessary for PSG, and how it should be interpreted from the result of the PSG tracing for the diagnosis for sleep apnea syndrome, etc.

Repair of the inferior alveolar nerve with a forearm cutaneous nerve graft after ablative surgery of the mandible

PURPOSE

A method of autologous nerve grafting for repair of the inferior alveolar nerve after mandibular resection using a forearm cutaneous nerve is described.

PATIENTS AND METHODS

The lateral cutaneous nerve of forearm served as the donor nerve, and the graft was inserted microsurgically using an epineurial nerve suture technique in 6 subjects. Return of sensation in these 6 patients was measured by the use of Semmes-Weinstein method.

RESULTS

Sensibility of the lower lip and chin recovered after about 10 months in all 6 subjects.

CONCLUSION

The lateral branch of the forearm cutaneous nerve is a useful graft for repair of the inferior alveolar nerve after mandibular resection in which a forearm flap is used as part of the reconstruction.

Sjögren syndrome associated with multiple myeloma of the IgA κ-type

Abstract We report a case of a 62-year-old female patient with Sjögren syndrome (SS) who developed multiple myeloma (MM) of the IgA κ-type. In 1986, the patient was admitted to our hospital with a facial rash, keratoconjunctivitis sicca, and xerostomia. She was diagnosed as having discoid lupus erythematosus (DLE) and SS. She was treated with bromhexine hydrochloride for SS and with topical fluorinated steroid for DLE. In 1992, she developed compression fractures of the lumbar vertebrae and was readmitted to our hospital. DLE was not recognized. Laboratory findings revealed IgA 2046 mg/dl, IgG 529 mg/dl, and IgM 21 mg/dl. Anti-SS-A antibody was 1 : 32 and anti-SS-B antibody was 1 : 2. M protein of IgA κ was demonstrated by immunoelectrophoresis. Aspiration biopsy of the bone marrow revealed 20.2% plasma cells. A bone scintigram demonstrated many hot spots at the cervical and lumbar vertebrae. She was diagnosed as having SS and MM of the IgA κ-type. After chemotherapy for MM, the percentage of plasma cells in the bone marrow and the concentration of serum IgA decreased to 6.2% and 532 mg/dl, respectively. SS is frequently associated with benign monoclonal gammopathy or lymphoproliferative disorders, especially Waldenström's macroglobulinemia or malignant lymphoma. Although benign monoclonal gammopathy has frequently been observed in patients with SS, SS associated with MM is extremely rare.

[Microscopic polyangiitis accompanying interstitial pneumonia with aluminum lung]

A 67-year-old man who had worked as an aluminum grinder had been given a diagnosis of pneumoconiosis. Ten years later, he was admitted with fever, dyspnea on exertion, and numbness. Chest roentgenograms showed linear-reticular shadows in both lower lung fields. ELISA-based tests were positive for perinuclear anti-neutrophil cytoplasmic antibody (P-ANCA). Renal biopsy specimens disclosed crescentic glomerulonephritis and angiitis of small arteries. Our diagnosis was microscopic polyangiitis accompanying interstitial pneumonia with aluminum lung. The results of high-energy dispersion X-ray microanalysis indicated that the patient's lungs contained aluminum. His general condition improved with the administration of corticosteroid and immunosuppressive agents, and his chief symptoms disappeared.

Effect of intravenous cyclophosphamide in systemic lupus erythematosus: relation to lymphocyte subsets and activation markers

Since the mechanism mediating the beneficial effect of intravenous cyclophosphamide (IVCY) in systemic lupus erythematosus (SLE) is unknown, we investigated lymphocyte subsets and markers of activated lymphocytes in patients received IVCY, and compared the results with the effect of steroid pulse. In 55 patients with SLE, 34 patients receiving IVCY [21 cases (61.8%) were responsive] and 25 patients received steroid pulse [21 cases (84.0%) were responsive] (four patients who were resistant to steroid pulse therapy were transferred to IVCY). When the lymphocyte subsets and markers of activated lymphocytes were compared in the responsive and unresponsive group of IVCY, soluble CD4 levels and the ratio of HLA-DP-positive T cells were significantly higher in the unresponsive group. Further, the changes of these markers and costimulatory molecules [LFA-1 (CD11a), ICAM-1 (CD54), CD40 and CD40-ligand (CD154)] were also examined in the responsive patients. The ratio of HLA-DP-positive T cells did not change in the IVCY-responsive group, while it decreased in the steroid pulse therapy-responsive group. The ratio of CD11a on T cells increased and CD54 on B cells decreased in the IVCY-responsive group. The ratio of CD154 on T cells increased in the steroid pulse-responsive group, while it decreased in the IVCY-responsive group. These results suggest that the effect of IVCY is different to that of steroid pulse therapy and mainly related to B cell activation, and that these markers may contribute to predict the responsiveness of IVCY.

Mutational analyses of restriction endonuclease-HindIII mutant E86K with higher activity and altered specificity

We have performed mutational analyses of restriction endonuclease HindIII in order to identify the amino acid residues responsible for enzyme activity. Four of the seven HindIII mutants, which had His-tag sequences at the N-termini, were expressed in Escherichia coli, and purified to homogeneity. The His-tag sequence did not affect enzyme activity, whereas it hindered binding of the DNA probe in gel retardation assays. A mutant E86K in which Lys was substituted for Glu at residue 86 exhibited high endonuclease activity. Gel retardation assays showed high affinity of this mutant to the DNA probe. Surprisingly, in the presence of a transition metal, Mo(2+) or Mn(2+), the E86K mutant cleaved substrate DNA at a site other than HindIII. Substitution of Glu for Val at residue 106 (V106E), and Asn for Lys at residue 125 (K125N) resulted in a decrease in both endonucleolytic and DNA binding activities of the enzyme. Furthermore, substitution of Leu for Asp at residue 108 (D108L) abolished both HindIII endonuclease and DNA binding activities. CD spectra of the wild type and the two mutants, E86K and D108L, were similar to each other, suggesting that there was little change in conformation as a result of the mutations. These results account for the notion that Asp108 could be directly involved in HindIII catalytic function, and that the substitution at residue 86 may bring about new interactions between DNA and cations.

Scleredema: report of a case

Abstract We describe a patient with scleredema. Thickened skin was observed in the posterior region of her neck, shoulders, and back. A skin biopsy revealed thickened dermis consisting of numerous thickened collagen bundles. Laboratory data revealed that she was suffering from diabetes mellitus (DM). The skin lesions ameliorated within a period of one month when her DM condition was controlled by oral hypoglycemics. Scleredema is a rare connective tissue disorder; its cutaneous manifestation should be distinguished from scleroderma.

Met5-enkephalin protects isolated adult rabbit cardiomyocytes via delta-opioid receptors

In rats and rabbits, endogenous opioid peptides participate in ischemic preconditioning. However, it is not known which endogenous opioid(s) can trigger cardioprotection. We examined preconditioning-induced and opioid-induced limitation of cell death in isolated, calcium-tolerant, adult rabbit cardiomyocytes. Cells were subjected to simulated ischemia by pelleting and normothermic hypoxic incubation. Preconditioning was elicited with 15 min of simulated ischemia followed by 15 min of resuspension and reoxygenation. All cells underwent 180 min of simulated ischemia. Cell death was assessed by trypan blue permeability. Morphine protected cells, as did preconditioning; naloxone blocked the preconditioning-induced protection. Exogenous Met5-enkephalin (ME) induced protection, but exogenous beta-endorphin did not. ME-induced protection was blocked by the delta-selective antagonist naltrindole. Additionally, two other proenkephalin products, Leu5-enkephalin and Met5-enkephalin-Arg-Phe, provided protection equipotent to ME. These data suggest that one or more proenkephalin products interact with delta-opioid receptors to endogenously trigger opioid-mediated protection.

[Does the present medical care system satisfy patients with home oxygen therapy (HOT) and home therapy with assisted ventilation (HTAV) in Japan?: an answer from a questionnaire analysis]

The aim of this study was to determine whether the present Japanese medical care system for home oxygen therapy (HOT) and home therapy with assisted ventilation (HTAV) satisfies patients (HOT & HTAV Pts) who receive these therapies. To clarify this issue, we sent questionnaires to 807 patients with HOT and HTAV, 816 practitioners (DRs), and 110 nursing stations (NSs) in metropolitan Tokyo. Responses were eventually received from 79.9% of HOT & HTAV Pts, 32.7% of Drs and 60.9% of NSs. As a result, going to hospitals on regular basis itself (1.3 times a month) forces HOT & HTAV Pts to spend a lot of money and time at present (22.4% spent more than 5,000 yen, and 15.5% more than 60 minutes for a consultation). Although a majority of HOT & HTAV Pts now see a respiratory specialist in larger hospitals, HOT & HTAV Pts wish to see DRs, if the DRs have sufficient ability in HOT and HTAV management. On the other hand, both DRs (86.9%) and NSs (90.6%) consider that case conferences and lectures regarding HOT and HTAV on a regular basis are essential. These meetings are attended by respiratory specialists, DRs, NSs, medical equipment dealers, HOT & HTAV Pts's family members and so forth, because both DRs and NSs feel a certain anxiety about seeing HOT & HTAV Pts (68.3% DRs and 7.5% NSs do not want to see HOT & HTAV Pts). In summary, 1) a majority of HOT & HTAV Pts remain unsatisfied with the present medical care system, 2) a vague anxiety about seeing HOT & HTAV Pts makes DRs tend to avoid HOT & HTAV Pts consultations, 3) NSs frequently feel unsure how to recognize and respond properly to problems concerning HOT & HTAV Pts (62.3%). We therefore conclude that if we could succeed in organizing a better medical care system for HOT & HTAV Pts than the present one, we could turn substantially improve the quality of life of HOT & HTAV Pts in Japan.