[Intercellular adhesion molecule 1 antigen in tuberculosis]

Intercellular adhesion molecule 1 (ICAM-1) plays an important role in inflammatory diseases. We investigated levels of circulating soluble ICAM-1 in patients with miliary tuberculosis (n = 8) and pulmonary tuberculosis (n = 49). We also attempted to compare ICAM-1 levels among pulmonary tuberculosis patients according to chest X ray classification of the Japanese Society for Tuberculosis. Significantly increased levels of circulating ICAM-1 were found in patients with miliary tuberculosis and extensive (extent 3) pulmonary tuberculosis (n = 9) compared to those of controls (n = 48), but not in patients with extent 1 (n = 24) or extent 2 pulmonary tuberculosis (n = 16). Immunohistochemical examination of the tuberculous lung tissues from the patients showed intensive cellular ICAM-1 on epithelioid cells and giant cells as well as on vascular endothelial cells. These results suggest that ICAM-1 is an important adhesion molecule in tuberculosis.

[Pregnancy and delivery in patients with lupus nephritis]

To investigate some of the problems associated with pregnancy and delivery in lupus nephritis, 13 pregnancies in 7 patients with inactive lupus nephritis and 5 pregnancies in one patient with primary antiphospholipid syndrome (PAPS) were compared with 36 pregnancies in 22 patients with primary nephrotic syndrome (NS). Furthermore, a follow-up survey during 0-8 years was made with 12 babies born to mothers with lupus nephritis. Some pregnancies during lupus nephritis were accompanied by disease exacerbation and worsening of renal function. There was a higher incidence of babies born with a low birth weight, and the incidences of fetal loss or premature birth and toxemia were higher in lupus nephritis than in NS. The number of babies with a low birth weight was significantly higher in patients with pregnancy-induced hypertension or skin lesion due to lupus erythematosus. The presence of antibodies against SSA/RO in the mother was associated with the occurrence of congenital heart block. Birth weight of babies born to mothers with lupus nephritis was low, but there were no statistical differences in the growth of babies after 6 months of age compared with babies born to normal women.

Staining pattern of type IV collagen and prognosis in early stage adenocarcinoma of the lung

AIMS

To examine the prognostic value of basement membrane expression in early stage adenocarcinoma of the lung.

METHODS

Using antibodies to type IV collagen, basement membrane expression at the tumour-stromal border was immunohistochemically analysed in 30 patients with early stage adenocarcinoma of the lung (pstage I and pstage II). Two patterns of staining for type IV collagen were observed: in the first one the staining line was conserved or partially fragmented; in the second the staining line was widely fragmented or absent in more than 10% of the tumour area. The first staining pattern was categorised as continuous and the second as discontinuous.

RESULTS

Of the 24 patients with pstage I adenocarcinoma, 12 (50%) cases showed a continuous pattern. In only one (16.7%) of the six patients with pstage II adenocarcinoma was this pattern evident. Five year survival was greater in pstage I adenocarcinoma (65%) than in pstage II adenocarcinoma (17%), but the difference was not significant. When the analysis was restricted to the 24 patients with pstage I adenocarcinoma, five year survival was better in continuous pattern cases (88%) than in discontinuous pattern cases (20.5%) (p < 0.05). The survival curve of 12 patients with pstage I adenocarcinoma and a discontinuous pattern resembled that of the six patients with pstage II adenocarcinoma.

CONCLUSION

These findings suggest that patients with pstage I adenocarcinoma and a discontinuous pattern have histopathologically unrecognised micrometastasis when they come to surgery. The staining pattern of type IV collagen could help in the prognosis of pstage I adenocarcinoma of the lung after surgery.

Anti-tumour activity of low-toxicity lipopolysaccharide of Bordetella pertussis

A lipopolysaccharide (BP-LPS) isolated from killed Bordetella pertussis (Tohama strain) was determined to have low toxicity based on the mortality and decrease in body weight of BP-LPS-injected mice. BP-LPS, administered intradermally or intraperitoneally, clearly inhibited the growth of an MM46 murine mammary carcinoma. When compared with a toxic Escherichia coli-derived LPS, BP-LPS displayed excellent anti-tumour activity against MH134 hepatoma and Meth A fibrosarcoma. As part of a combined chemotherapy/immunotherapy regimen, BP-LPS also seemed to prolong the lifespan of mice inoculated with Lewis lung carcinoma. BP-LPS thus appears to have valuable characteristics as an anti-tumour agent.

[Expression of integrin molecules in sarcoid lesions]

In order to assess the role of adhesion molecules in sarcoid lesions, we examined the expression of integrin families and extracellular matrix proteins by immunohistochemical techniques in sarcoid lymph nodes. Epithelioid cells exhibited intensive expression of ICAM-1, the alpha 5 and the beta 2 molecules. Lymphocytes exhibited intensive expression of ICAM-1, the alpha 4, the alpha 5 and beta 2 molecules. Laminin and type IV collagen were detected at basement membranes in vessels. Fibronectin was distributed within granulomas with a concentric pattern and around granulomas with a fibrillar pattern. Its distribution was well correspondence with the alpha 5 expression. These data suggest that integrin families might play an important role in granuloma formation and migration of lymphocytes into inflamed sarcoid lesions.

[Experimental and clinical studies on lower esophageal sphincter motor function with special reference to the influence of vagal denervation]

Dysmotility of lower esophageal sphincter (LES) is common following gastric surgery. This may result in gastroesophageal reflux which frequently seen following gastric surgery. The aim of this study was to determine the effect of various surgical procedures on esophagogastric motility in dog and human. Esophago-gastric motility was investigated by strain gauge transducers during fasted and fed state in conscious dogs. Motility recordings were performed in three groups of dogs; 1) control dogs, 2) with truncal vagotomized dogs (TV), 3) with selective proximal vagotomized dogs (SPV). In human, manometric recordings were performed before and after gastric surgery (SPV or distal partial gastrectomy). In control animals, lower esophagus and LES contracted simultaneously with each contractions of the stomach during interdigestive motor contractions in fasted state. In fed state, LES showed tonic contractions, while gastric body showed receptive relaxation. These motility pattern of LES was considered to prevent gastroesophageal reflux in both fasted and fed states. These coordinated LES contractions disappeared following SPV or TV. In human, the amplitude and velocity of esophageal propagating contractions deceased after SPV or distal partial gastrectomy. In conclusion, gastric surgeries such as SPV, TV and/or distal partial gastrectomy caused LES dysmotility. These phenomena explain frequent gastroesophageal reflux following gastric surgery. Supplementation of anti-reflux procedure for gastric surgery should be required in the prevention of gastroesophageal reflux following gastric surgery.

Analysis of restriction fragment length polymorphism for the HLA-DR gene in Japanese patients with sarcoidosis

BACKGROUND

It is commonly assumed that some immunological disorder may play a part in the pathogenesis of sarcoidosis. Previous studies by several groups have shown a significant association with HLA-DR antigens in patients with sarcoidosis. In this study, restriction fragment length polymorphism (RFLP) analysis of the HLA-DR gene was designed to confirm the association at the gene level and to look for a gene rearrangement which may influence susceptibility to sarcoidosis.

METHODS

Thirty two unrelated Japanese patients with sarcoidosis were tested for HLA antigens and subjected to RFLP analysis after digestion with Eco RI, Pst I, Bam HI, Pvu II, and Hind III by using an HLA-DR beta cDNA probe. A group of 47 unrelated healthy Japanese subjects served as controls. Frequencies of each restriction fragment were compared between the patients and the control subjects. Correlation between fragment frequencies and clinical features were also analysed.

RESULTS

No restriction fragments of HLA-DR beta gene were found specific to the patients with sarcoidosis. The RFLP analysis could detect polymorphism of HLA-DR beta genes that was not distinguishable by conventional serological methods. Several restriction fragments of the DR beta gene were seen only in DRw52 positive individuals, and showed higher frequencies in the patients than in control subjects. The patients with these DNA fragments were likely to have limited stage disease with no ophthalmic involvement.

CONCLUSIONS

An association between HLA and sarcoidosis was noted at the DNA level, although no restriction fragments were specific for this disease. RFLP analysis of the HLA gene is a more useful method than the usual HLA typing, and should be the first step in identifying the gene sequence which is connected with susceptibility to sarcoidosis.

A rapid colorimetric assay for determination of leukocyte-mediated inhibition of mycelial growth of Candida albicans

A staining method with crystal violet (CV) was demonstrated to be useful for a simple, quick and objective assessment of in vitro growth inhibitory activity of leukocytes against Candida albicans cells. Candida cells incubated with murine neutrophils or macrophages for 14 hr in microwells were stained with CV and, after washing with 0.25% sodium dodecyl sulfate (SDS), treated with isopropanol containing HCl (0.04 N) to extract Candida cell-bound CV. Then the absorbance at 590 nm of the isopropanol extract was photometrically measured. The results showed that the photometrical absorbance was proportional to the amount of 3H-glucose taken up by C. albicans cells, which reflected the number of viable Candida cells.

Adenosine-induced heterogeneous perfusion accompanies myocardial ischemia in the presence of advanced coronary artery disease

The aim of the present study was to elucidate the characteristics of patients in whom transient myocardial ischemia was evoked during adenosine infusion. Thallium-201 (Tl-201) myocardial imaging and two-dimensional echocardiography during adenosine infusion were performed simultaneously in 61 consecutive patients enrolled for the diagnosis of coronary artery disease. Transient reduction of systolic wall motion after adenosine infusion was considered evidence of myocardial ischemia. Tl-201 redistribution was noted in 38 patients, and 23 of them showed a wall motion abnormality during adenosine infusion. Stepwise discriminant analysis was applied to eight variables that showed significant differences by the univariate analysis between patients with the presence and the absence of adenosine-induced wall motion abnormality: myocardial infarction, anginal pain, ST depression, collateral vessels, Tl-201 redistribution, number of diseased vessels of > or = 75% or 90% stenosis and number of segments with Tl-201 redistribution. The number of diseased vessels with > or = 75% stenosis (F = 43.5, p < 0.0001), ST depression (F = 16.0, p < 0.0002), collateral vessels (F = 11.7, p < 0.001) and Tl-201 redistribution (F = 5.6, p < 0.02) were the statistically significant discriminators relating to adenosine-induced wall motion abnormality. Adenosine-induced myocardial ischemia was related to the number of coronary stenoses, reflecting the presence of severe coronary artery disease, and well-developed collaterals that might be integral factors in a coronary steal phenomenon.

[Clinical indicators of malignancy of lung cancer]

To evaluate the malignancy of lung cancer, nuclear DNA content, AgNORs counts and cathepsin B activity were examined. The survival time of small cell carcinoma patients with limited disease of near diploid is longer than that with limited disease of hyperdiploid pattern. By flow cytometric technique, the proportion of DNA aneuploid pattern were higher in adenocarcinoma than in squamous cell carcinoma. In squamous cell carcinoma, the prognosis of patients with DNA aneuploid pattern was worse. However, there was no significant difference in survival time of adenocarcinoma patients. A good correlation between the AgNORs counts and tumor volume doubling time of non-small cell carcinoma of lung was observed. However, the AgNORs counts were an independent prognostic factor for survival time of patients with lung cancer. The survival time of lung cancer patients with the marked intensity of cathepsin B was significantly shorter than that of patients with negative and/or weak positive staining pattern. The AgNORs value and cathepsin B activity can serve as a pertinent marker for clinical assessment of malignancy of lung cancer.

The t(X;18)(p11.2;q11.2) translocation found in human synovial sarcomas involves two distinct loci on the X chromosome

A high proportion of synovial sarcomas contain the reciprocal translocation t(X;18)(p11.2;q11.2). We have previously localized the breakpoint on the X chromosome between the X chromosome marker DXS255 and an ornithine aminotransferase (OAT) pseudogene region designated OATL2. Subsequently by fluorescence in situ hybridization (FISH) we provided evidence that YACs corresponding to the OATL2 locus spanned the break-point. In order to confirm the position of this breakpoint cosmids corresponding to the OATL2 region were isolated. Most of these cosmids mapped to four cosmid contigs designated C1-C4. Analysis of two contigs, C1- and C4, using FISH established that in four of six synovial sarcomas examined the breakpoint occurs between these two contigs: C1 lies distal to the break-point while C4 is proximal. In contrast we provide evidence that the breakpoint in the remaining two tumours mapped to a second pseudogene region called OATL1 that is telomeric to the OATL2 locus. This heterogeneity of the breakpoint position on the X chromosome explains why in previous mapping studies there have been discrepancies between the results obtained by different laboratories.

Clinical experience of Hokkaido University-PACS and FCR-angiography

Three years' experience with Hokkaido University-PACS (HU-PACS) is reported. In particular, this paper describes the suitability of FCR-angiography for HU-PACS, which has been in clinical use since March 1991. Image quality of FCR-arteriograms was evaluated in the head-and-face region and the abdominal region independently. The image quality in both regions was excellent. Quality of transferred images to image workstation for HU-PACS with 10:1 data compression was also evaluated, and no appreciable image degradation or loss of information was found in the transferred images. There was no significant difference in the examination time required for one patient in abdominal angiography between conventional angiography and FCR-angiography. In summary, FCR-angiography is suitable for HU-PACS as its image acquisition modality.

Early assessment of reperfusion therapy using cardiac troponin T

OBJECTIVES

The purpose of this study was to investigate the utility of cardiac troponin T for early assessment of reperfusion therapy.

BACKGROUND

Several biochemical markers are used for early noninvasive detection of reperfusion during intravenous thrombolytic therapy. However, cardiac troponin T, a new myocardial-specific marker, has not been used previously for this purpose.

METHODS

We measured troponin T and creatine kinase, MB isoenzyme (CK-MB) levels in 38 patients with acute myocardial infarction whose infarct-related artery was totally occluded before reperfusion therapy. Subjects comprised 14 patients with successful angioplasty (group 1), 12 patients with successful thrombolytic therapy (group 2) and 12 patients with unsuccessful attempted reperfusion (group 3). Blood samples were taken every 15 min, and coronary angiography was performed every 5 to 8 min until 60 min after reperfusion (groups 1 and 2) or after the initiation of treatment (group 3). We calculated the increase in troponin T (delta troponin T) and CK-MB (delta CK-MB) 60 min after treatment was initiated and 60 min after reperfusion in groups 1 and 2.

RESULTS

Mean (+/- SD) delta troponin T and delta CK-MB levels were 9.35 +/- 7.83 ng/ml and 125 +/- 83 mU/ml in group 1 and 3.23 +/- 3.08 ng/ml and 130 +/- 137 mU/ml in group 2, respectively, 60 min after treatment and were 10.1 +/- 8.35 ng/ml and 131 +/- 84 mU/ml in group 1 and 6.84 +/- 8.30 ng/ml and 158 +/- 146 mU/ml in group 2, respectively, 60 min after reperfusion. These values were significantly higher than those 60 min after treatment in group 3: 0.16 +/- 0.19 ng/ml and 10 +/- 9 mU/ml, respectively. The predictive accuracy for detecting reperfusion using a threshold value of 0.50 ng/ml of delta troponin T and 25 mU/ml of delta CK-MB was 100% in group 1 and 92% in group 2 60 min after treatment, respectively. There was significant correlation between delta troponin T and delta CK-MB.

CONCLUSIONS

Serial measurements of cardiac troponin T as well as of CK-MB are useful for early assessment of reperfusion therapy.

Organ distribution of thallium-201 during intravenous adenosine infusion: comparison with exercise

Thallium-201 (Tl-201) distribution during adenosine infusion was assessed quantitatively and compared with that of exercise imaging. Adenosine and exercise Tl-201 single-photon emission computed tomography (SPECT) were performed in 40 patients with suspected coronary artery disease. In the whole-body images (n = 5) and the unprocessed anterior projection images acquired as part of the initial imaging (n = 35), Tl-201 counts in the myocardium were normalized for the injected dose. Total heart counts were higher during adenosine infusion than during exercise (190 +/- 43 counts/MBq vs 145 +/- 31 counts/MBq, p < 0.01). A heart-to-lung count ratio between adenosine infusion and exercise was not different. A heart-to-liver count ratio was lower during adenosine infusion than during exercise (1.3 +/- 0.3 vs 2.3 +/- 0.5, p < 0.01). Regional Tl-201 uptakes at the inferior wall of the left ventricle during adenosine infusion were closely correlated with those uptakes during exercise (r = 0.94, p < 0.01, slope = 0.96). The sensitivity, specificity, and accuracy of adenosine Tl-201 SPECT for the detection of right coronary artery stenosis were comparable with those of exercise imaging. These results indicated that higher Tl-201 uptake in the liver during adenosine than during exercise did not interfere with the interpretation of myocardial images. Tl-201 counts in the myocardium that were larger during adenosine infusion than during exercise reflected a larger increase in coronary blood flow and thus resulted in better image quality.

Inhibition of Candida albicans growth by murine peritoneal neutrophils and augmentation of the inhibitory activity by bacterial lipopolysaccharide and cytokines

Anti-Candida activity of murine neutrophils and its regulation by immunomodulators were studied in vitro. Murine neutrophils which were prepared from peritoneal-exudated cells inhibited the growth of Candida albicans at an effector: target (E/T) ratio of 30/1 or above. This anti-Candida activity of neutrophils was augmented by lipopolysaccharide from Escherichia coli, murine tumor necrosis factor (TNF), murine interferon-gamma (IFN-gamma) and murine granulocyte macrophage colony-stimulating factor (GM-CSF) but not by granulocyte colony-stimulating factor (G-CSF) added to the incubation medium. Greater extent of augmentation was obtained when TNF plus GM-CSF or INF-gamma plus GM-CSF were used in combination. These results indicate that anti-Candida activity of murine neutrophils is regulated similarly to that of the human neutrophils reported previously. Therefore murine peritoneal neutrophils can be used as a favorable substitute for human neutrophils in studies on protective machinery against C. albicans infection.

[Use of MRI in the diagnosis of dementia of the Alzheimer type]

MRI of 31 patients with dementia of the Alzheimer type (DAT) (mean age 74.7 years) were studied to detect characteristic findings, and compared with those of 24 normal elderly controls (mean age 74.1 years). Atrophy was quantitated by planimetric and linear measurements, and periventricular and deep white matter signal abnormalities were assessed by subjective ratings. Although we observed significant differences between the DAT patients and controls, there was overlap in each of the measurements. Of these, the ratio of the temporal horn area and the pattern of linear measurements (the width of the temporal horn body--the medial temporal lobe width--the interuncal distance) best distinguished the DAT patients from controls. Twenty-five patients (81%) had a ratio of the temporal horn area larger than the value of the mean + 2SD of the controls. AV-shaped pattern, in which the medial temporal lobe width was smaller than the other two values, was demonstrated in 84% of the patients and only 8% of the controls. Although signal abnormalities were not useful for diagnostic purposes, periventricular hyperintensities were more commonly seen in the DAT patients than in the controls, and correlated with cognitive function. MRI studies suggest that the assessment of medial temporal lobe atrophy is useful in the diagnosis of DAT, and periventricular hyperintensity may be related in some way to the disease process.

[Clinical experiences of granulocyte colony stimulating factor for granulocytopenia after AC bypass]

We have successfully treated 3 cases of granulocytopenia, using Granulocyte Colony Stimulating Factor (G-CSF) after AC bypass surgery. All cases were male, aged 68, 75 & 54 years old, and underwent AC bypass surgery without transfusion except in case 1. Granulocyte cell counts decreased to 135/mm3 on 39th post-operative days (POD) in case 1, 624/mm3 on 13 rd POD in case 2, and 514/mm3 on 20th POD in case 3. In case 1, 300 micrograms of G-CSF was given intravenously for 3 days. In case 2, 100 micrograms of G-CSF for 1 day and 50 micrograms for 3 days was given subcutaneously, and in case 3, 100 micrograms of G-CSF was also given subcutaneously for 2 days. And their granulocyte cell counts all increased within few days. G-CSF is effective for patients with granulocytopenia after AC bypass surgery, but we need more experiences to know the best way of administration.

Rapid diagnosis of coronary reperfusion by measurement of myoglobin level every 15 min in acute myocardial infarction

OBJECTIVES

The purpose of this study was to examine whether coronary reperfusion can be diagnosed rapidly and accurately by myoglobin measurements.

BACKGROUND

When intravenous thrombolysis is used for acute myocardial infarction, it is important to determine coronary reperfusion rapidly and noninvasively so that further treatment can be initiated.

METHODS

We determined myoglobin, creatine kinase (CK) and creatine kinase, MB fraction (CK-MB) isoenzyme levels in 63 patients with acute myocardial infarction with total occlusion of the infarct-related artery that was confirmed by coronary angiography. Myoglobin was measured by turbidimetric latex agglutination, which has an assay time of 10 min. We measured myoglobin, CK and CK-MB every 15 min in 45 patients with and 18 patients without reperfusion. The condition of the infarct-related artery was confirmed every 5 to 8 min by coronary angiography.

RESULTS

The rate of increase in myoglobin, CK, and CK-MB at 15, 30, 45 and 60 min after treatment and reperfusion was significantly higher in the reperfused than in the nonreperfused group. In the reperfused group, the rate of increase in myoglobin was significantly higher than the corresponding rate of increase in CK and CK-MB at 15, 30 and 45 min after reperfusion. When reperfusion was evaluated on the basis of a cutoff level (myoglobin > or = 2.0, CK > or = 1.8, CK-MB > or = 1.5), the predictive accuracy of myoglobin (95%) was significantly higher than that of CK (68%) and CK-MB (73%) at 15 min after reperfusion.

CONCLUSIONS

Coronary reperfusion can be rapidly and accurately detected by measurement of the plasma myoglobin every 15 min.

[A case of primary pulmonary cryptococcosis with increased serum carcinoembryonic antigen]

A case of primary pulmonary cryptococcosis with increased serum carcinoembryonic antigen (CEA) (7.0 ng/ml) is presented. The diagnosis was made by transbronchial lung biopsy (TBLB) and no abnormality was found in either gastrointestinal tract or immunity. Immunohistochemical study of the lung specimen showed that CEA was present on the surfaces of alveoli. The level of CEA fell to 0.8 ng/ml after administration of an antimycotic agent (Fluconazole) with simultaneous improvement of the chest radiographic findings. This case indicates that increased serum CEA depends on pulmonary cryptococcosis. TBLB and administration of antimycotic agents, instead of surgical resection, are useful in the diagnosis and treatment of this disease.

Serial changes in coagulant activities after thrombolytic therapy for acute myocardial infarction

Early reocclusion and bleeding complications are still unresolved problems in thrombolytic therapy for acute myocardial infarction (AMI). In the present study, 16 patients treated with either fibrin-specific tissue-type plasminogen activator (t-PA) or nonspecific urokinase (UK) were studied to determine the effects of thrombolytic therapy on serial hemostatic states. Hemostatic states of each patient were estimated by measuring various plasma markers at one- to two-hour intervals during the first six hours of therapy, daily during the next three days, and subsequently on day 7. Two markers of plasma thrombin generation, thrombin antithrombin III complex (TAT) and prothrombin fragment 1 + 2 (F 1 + 2), showed an activated coagulant state immediately after thrombolytic therapy. The amount of thrombin generation indicated by these markers showed significant positive correlation with direct markers of fibrinolysis such as fibrin degradation products (FDP), while it did not show any correlation with the markers for plasmin generation. The potential for coagulation as indicated by prothrombin time (%) decreased with thrombolysis using fibrin nonselective agents, owing perhaps to destruction of coagulant factors by free plasmin. Fibrinolytic activity induced by thrombolytic therapy for AMI caused transient activation of the coagulant system, which could contribute to early reocclusion. Fibrin nonselective agents decreased the potential for coagulation by destroying clotting factor through the generation of free plasmin. These data provide theoretical support for simultaneous administration of anticoagulant therapy with fibrin-specific thrombolytic agents.

Impaired biliary excretion of copper and lysosomal enzymes in Long-Evans cinnamon

Although impaired biliary excretion of copper through hepatocyte lysosomes has been postulated as a pathogenesis of Wilson's disease, direct evidence has been lacking. Our aim was to investigate the dynamics of biliary excretion of copper and lysosomal enzymes in the Long-Evans Cinnamon (LEC) rat, a recently established rodent model of Wilson's disease. Liver homogenate and bile were obtained from 12 week-old LEC rats (n = 7), Long-Evans Agouti rats (n = 3) and Sprague-Dawley rats (n = 8) and analyzed for copper and lysosomal enzymes. Structural integrity of hepatic lysosomes was assessed by the latency of N-acetyl-beta-glucosaminidase. Compared with the controls, LEC rats exhibited a 43-fold increase in hepatic copper concentration (p < 0.001), a significant increase in hepatic activities of lysosomal enzymes (p < 0.001) and reduction of lysosomal latency (p < 0.05). In contrast, biliary excretion of copper and lysosomal enzymes were significantly impaired in LEC rats (p < 0.05). These results suggest a coupled alteration between copper and lysosomal enzymes in both the liver and bile of LEC rats (i.e., increase in liver and decrease in bile). Defective biliary excretion of copper via hepatocyte lysosomes may play a role in part in spontaneous copper accumulation in LEC rats.