[Immunoregulatory cells in patients with monoclonal gammopathies]

The authors detected immunoregulatory cells by two-color cytometric analysis in the peripheral blood of 21 patients with multiple myeloma (MM) and 10 patients with monoclonal gammopathy of undetermined significance (MGUS). CD3-CD56+ cells increased in both MGUS and IgG, IgA type MM in clinical stage (CS) I & II, whereas CD3+ cells decreased. On the other hand, the CD4/8 ratio, the proportions of CD45RA+ cells and CD29++ cells in CD4+ cells, and S6F1++ cells in CD8++ cells remained normal. In CS III MM of IgG and IgA type, CD3-CD56+ cells did not increase, although CD3+ cells decreased. Additionally, both CD4/8 and CD4+ CD45RA+/CD4+ ratios were low, while the proportions of CD29++ cells in CD4 cells and S6F1++ cells in CD8++ cells were high. However, this type of change in the T-cell subset balance was not observed in CS III MM of the Bence-Jones type, which showed no significant elevation of serum M-protein. These findings suggest that serum monoclonal idiotypes could affect immunoregulatory cells, especially T cells.

Stereoselective renal tubular secretion of an organic anion in the isolated perfused rat kidney

To clarify the stereoselective renal tubular secretion of an organic anion, renal excretion of 5-dimethylsulfamoyl-6,7-dichloro-2,3-dihydrobenzofuran-2-carbox yli c acid (DBCA), a racemic compound, was studied with a single-pass perfused rat kidney preparation under constant perfusion pressure (ca. 120 mm Hg). The steady-state renal extraction ratio of (R)-(+)-DBCA (0.134) was 10 times higher than that of (S)-(-)-DBCA (0.015), indicating high selectivity for (R)-(+)-DBCA. The urinary excretion rate and renal excretory clearance (CLrex) were 4 times larger for (R)-(+)-DBCA, and the unbound fraction in the perfusate also was higher for (R)-(+)-DBCA (R/S = 1.58). Fractional excretion (FE) and intrinsic clearance for tubular secretion (CLrsec,int) were about 3 times larger for (R)-(+)-DBCA than the antipode, showing the stereoselectively predominant secretion of (R)-(+)-DBCA. The N-monodemethylated metabolite, M-1, was found only for the R-(+)-enantiomer in the perfusate and urine, revealing highly stereoselective N-monodemethylation in the kidney. The CLrsec,int value for (R)-(+)-M-1 was 2.5 times larger than that for (R)-(+)-DBCA. The perfusion study using each enantiomer decreased R/S ratios of the extraction ratio (9.9), urinary excretion rate (3.9) and excretory clearance (3.9) in the perfusion of the racemate to 3.9, 2.1 and 2.1, respectively. No significant difference was found between (R)-(+)- and (S)-(-)-DBCA in FE and Clrsec,int. The declined stereoselectivity in renal excretion parameters may be due to competitive inhibition of the tubular secretion of (R)-(+)-DBCA by the (R)-(+)-M-1 formed which possessed greater secretion ability in the (R)-(+)-DBCA perfusion study, whereas (S)-(-)-DBCA was secreted without great inhibition by (S)-(-)-M-1 in the (S)-(-)-DBCA perfusion because of a small amount of generated metabolite. Plotting of FE ratios of DBCA enantiomers to (R)-(+)-M-1 against FE of (R)-(+)-M-1 suggests that the actual FE for (R)-(+)-DBCA was 2 times larger than that for (S)-(-)-DBCA, and that (S)-(-)-DBCA secretion was inhibited more easily by (R)-(+)-M-1.

[Experimental study of differentiation between tumor and inflammation using MR imaging: correlation between VX2 tumors and croton oil induced inflammation in the rabbit's femoral muscle]

We evaluated the various Magnetic Resonance (MR) sequences for differentiation between tumors and inflammation. Experimental models of rabbit's tumors (VX2) and inflammation induced by croton oil in the femoral muscle were used for this evaluation. Both types of lesions presented a high intensity area on T2-weighted and heavy T2-weighted images. An inflammatory lesion was revealed with iso-/low intensity area and tumors were defined as high signal lesions on Sinc saturation fat suppression T1-weighted, standard T1-weighted and fat suppression T1-weighted images by the 3 Point dixon method. T1, T2 values of tumor and inflammatory lesions were also measured. The T1 value of the tumors was 1186 +/- 58 msec (n = 5) and that of the inflammatory lesion was 1097 +/- 40 msec (n = 3). The T2 value of the tumors was 71 +/- 13 msec (n = 5) and that of the inflammatory lesions was 70 +/- 5.5 msec (n = 3). There were no significant differences between both the T1 and T2 values. Calculated relative proton density was 0.69 +/- 0.14 (n = 4) in the tumors, and 0.42 +/- 0.12 (n = 3) in the inflammatory lesions. A statistical difference (p < 0.05) was found in both value. These results suggest that a T2-weighted image is not useful for differentiation between tumors and inflammation, and a T1-weighted image might be useful for such differentiation. This phenomenon is related to the difference of the proton density.

Hematopoietic supportive function of human bone marrow stromal cell lines established by a recombinant SV40-adenovirus vector

We have previously reported the establishment of a variety of human bone marrow stromal cell lines using a recombinant SV40-adenovirus vector. Using this vector, we obtained more clonal stromal cells. Here, we have characterized these cells and analyzed their capacity to support the proliferation and differentiation of hematopoietic cells. The stromal cells were cocultured with nonadherent human bone marrow cells used as hematopoietic cells. The total numbers of hematopoietic cells and CFU-GM in culture were counted every week. Two of the six stromal cell lines, AA101 and HAS303, supported the proliferation and differentiation of hematopoietic cells and CFU-GM for more than 9 weeks. Further, granulocytes, macrophages, and megakaryocytes were detected when cocultured with these cells. When hematopoietic cells were cocultured but separated from the two stromal cell lines by a 0.45-microns millipore membrane to prevent their attachment, almost all CFU-GM disappeared within 7 weeks. The supportive stromal cells produced GM-CSF and IL-6. However, other cell lines producing these humoral factors did not support hematopoietic cell proliferation for such a long time. These findings suggest that these established human bone marrow stromal cell lines will be useful, in that analysis of their supportive function in hematopoietic cell proliferation and differentiation through cell-to-cell interaction will shed some light on this area.

[Diagnosis of B-cell lymphoma of lung by kappa-lambda imaging in broncho-alveolar lavage fluid lymphocytes]

We attempted to verify the clonality of proliferating cells in broncho-alveolar lavage fluid (BALF) by using a sophisticated technique known as kappa-lambda imaging. We applied this method to BALF lymphocytes from 3 cases suspected of having primary pulmonary B-cell lymphoma, by transbronchial lung biopsy, and from 2 cases with B-cell lymphoma revealing abnormal shadows. (One was diagnosed as small cell carcinoma, the other mycotic infection). B-cell monoclonality was found in the former 3 cases, but not in the latter 2 cases. We conclude that kappa-lambda imaging in BALF lymphocytes is useful for diagnosing B-cell lymphoma of the lung.

[Prophylactic oral antibiotics in urethral instrumentation]

Between July 1990 and December 1992, the incidence of infection after 1,249 urethral manipulations on patients, who had no urinary infection before the manipulation, was studied. Infections developed in 21 patients (1.7%). The prophylactic 3-day antimicrobial medication reduced the development of infection to 5/790 (0.6%), in contrast to 16/459 (3.5%) among patients who did not take the prophylactic antimicrobial (P = 0.0004). Of the procedures studied, urethral dilation with sounds and retrograde urethrography were not so dangerous as cystoscopic examination. After cystoscopic examinations, 5 (1.4%) out of 347 males with prophylactic antimicrobial developed infection, although none of the prophylacted 135 females developed infection. Elderly persons had greater risk of developing the infection. The most disastrous bacteria was P. aeruginosa.

Protein phosphorylation in murine peritoneal macrophages induced by infection with Salmonella species

Infection of peritoneal macrophages from C3H/HeN and C3H/HeJ mice with Salmonella typhimurium or S. enteritidis induced extensive phosphorylation in a set of proteins with molecular masses of 85, 72, 35, 30, and 23 kDa, which were different from those induced by bacterial lipopolysaccharide. The phosphorylated proteins of 35, 30, and 23 kDa (pp35, pp30, and pp23, respectively) originated from the infecting bacteria, because living bacteria could induce these phosphorylated proteins themselves, and no induction of the proteins occurred in macrophages after phagocytosis of heat-killed or UV-irradiated organisms. When the infected macrophages were disrupted and separated into bacterial and macrophage debris fractions, pp85 and pp72 remained in the macrophage debris fraction, with none in the bacterial fraction. Induction of pp85 and pp72 in infected macrophages was inhibited in the presence of chloramphenicol but not cytochalasin D, suggesting that bacterial growth in the macrophages is necessary for induction of both proteins. Neither of these proteins could be detected in macrophages infected with Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus, or Listeria monocytogenes. These results support the view that phosphorylation of the 85- and 72-kDa proteins occurs in the macrophages during the early phases of the interaction between Salmonella organisms and macrophages. The functions of specific proteins remain to be clarified.

[Immunocompetent cells in lymph nodes of B-cell lymphomas]

In non-Hodgkin's lymphoma (NHL), the precise analysis of non-neoplastic immunocompetent cells in lymph nodes may be important to understand the pathophysiology of anti-tumor immunity. We have investigated such immunocompetent cells of 14 patients with B-cell type NHL (B-NHL) by flow cytometry, and compared them with the data obtained from 10 patients with reactive lymphadenopathy. The results on B-NHLs were as follows; CD3+ (T lymphocyte) = 45.0 +/- 19.7%, CD4+/CD3+ = 62.7 +/- 14.2%, CD4+CD45RA-/CD4+ = 82.9 +/- 8.1% (Control 62.9 +/- 14.5%, p < 0.01), CD4+CD29++/CD4+ = 29.2 +/- 7.0% (Control 42.6 +/- 12.9%, p < 0.01), CD8+/CD3+ = 36.0 +/- 11.3%, CD8++S6F1++/CD3+ = 23.2 +/- 10.6% (Control 9.1 +/- 4.3%, p < 0.01), CD8++S6F1++/CD8++ = 75.3 +/- 16.7% (Control 41.5 +/- 19.6%, p < 0.01), CD3-CD56+ cells = 1.0 +/- 0.7% (Control 2.2 +/- 1.6%, p < 0.05). These findings suggest that CD4+ T lymphocytes in lymph nodes of B-NHL may change to memory cells (CD45RA- cells), but such memory cells could only weakly express CD29 molecules which are thought to play an important role in the manifestation of helper function. This phenotypic discordance of CD4+ T lymphocytes may produce incomplete anti-tumor immunity in B-NHL.

Radical radiation therapy for adenocarcinoma of the uterine cervix

PURPOSE

Analysis of the therapeutic value of radical irradiation for patients with uterine cervical adenocarcinoma with special reference to pelvic disease control.

PATIENTS AND METHODS

20 patients with uterine cervical adenocarcinoma were treated with a combination of external beam and intracavitary irradiation (four patients stage IB, one stage IIA, three stage IIB and twelve patients stage IIIB). Seven patients were treated with high dose-rate (HDR) intracavitary irradiation, eleven with low dose-rate (LDR) intracavitary irradiation and two with HDR and LDR.

RESULTS

Six out of the 20 patients experienced pelvic recurrence (all stage IIIB patients). Analysis of the relation between pelvic recurrence and dose rate of intracavitary irradiation revealed that LDR showed a higher pelvic disease control rate than HDR (6/7 vs. 0/4) in stage IIIB patients. Intracavitary irradiation doses of LDR were 1.2 to 1.5 times higher than those of HDR. Three out of the 20 patients developed rectal complication grade 2 (two patients treated with HDR, one with LDR). The five-year cumulative survival rate was 67.2% for all, 100% for stage I and II, and 43.3% for stage IIIB patients.

CONCLUSION

These results suggest that locally advanced uterine cervical adenocarcinoma should be treated with a higher dose using LDR intracavitary irradiation. If adequate total doses can be delivered, pelvic disease control of uterine cervical adenocarcinoma is comparable with that achieved for squamous cell carcinoma.

Cross-reactivity and neutralizing ability of monoclonal antibodies against microcystins

Monoclonal antibodies (MAbs) against the microcystin-leucine-arginine variant (MCYST-LR), a cyclic peptide toxin of the freshwater cyanobacterium Microcystis aeruginosa, were prepared from cloned hybridoma cell lines. The specificity of the MAbs and their ability to neutralize the toxin were investigated by an indirect enzyme-linked immunosorbent assay (ELISA) and by a neutralizing test in mice, respectively. All MAbs reacted with MCYST-LR and also with the microcystin-arginine-arginine variant (MCYST-RR), 3,7-didesmethylmicrocystin (MCYST-3, 7-dDMLR) and 7-desmethylmicrocystin (MCYST-7-DMLR). Furthermore, the antibodies reacted with cell-extracts of toxic and non-toxic M. aeruginosa strains. The MAbs can apparently recognize the common configuration, but not the variant-specific structure, in the microcystin molecules. The non-toxic strains apparently contain some substance(s) related antigenically to microcystin. The in vivo toxin-neutralizing ability of MAbs was minimal.

pH-sensitive dissociation and association of beta-N-acetylhexosaminidase from boar sperm acrosome

beta-N-Acetylhexosaminidase (beta-Hex, EC, 3.2.1.52) was released from cauda epididymal boar sperm by treatment with ionophore A23187, indicating that this enzyme is localized in the acrosome. beta-Hex was extracted on a large scale, with 2% acetic acid containing 0.2% Brij 35, from washed ejaculated sperm. By gel filtration chromatography, beta-Hex was separated into a high-molecular-weight fraction (beta-Hex I) and a low-molecular-weight fraction (beta-Hex I). beta-Hex I, which is predominant under acidic conditions (pH 6.5), dissociated into beta-Hex II under alkaline conditions (pH 7.4). beta-Hex II, converted from beta-Hex I, associated again to form beta-Hex I under acidic conditions. By sequential chromatography on ion-exchange, lectin, gel filtration, and ion-exchange HPLC columns, beta-Hex I and II were purified 1200-fold and 4000-fold, respectively, with a combined recovery of 23% as measured with synthetic substrate. An inhibitor of beta-Hex, O-(2-acetamido-2-deoxy-D-glucopyranosylidene) amino N-phenyl-carbamate (PUGNAC), reduced the in vitro fertilization rate in porcine cumulus-enclosed eggs, but barely changed the rate when cumulus-free eggs were used. beta-Hex I was shown to possess cumulus dispersion activity, suggesting that beta-Hex plays a role in the passing by sperm through cumulus cells before they bind to the zona pellucida.

Multistep regulation mechanisms for tolerance induction to lipopolysaccharide lethality in the tumor-necrosis-factor-alpha-mediated pathway. Application of non-toxic monosaccharide lipid A analogues for elucidation of mechanisms

Lipid A is the active principle of lipopolysaccharide (LPS). Synthetic lipid A analogues with monosaccharide backbones, GLA-60, GLA-69 and GLA-58, which exhibit potent, weak and scarce agonistic activities of LPS, respectively, induced tolerance against LPS lethality in galactosamine-(GalN)-sensitized mice while none of them were pyrogenic in rabbits. The tolerance-inducing mechanisms were investigated focusing on the regulation of tumor-necrosis-factor-alpha(TNF-alpha)-mediated lethal pathway of LPS. Induction of serum TNF-alpha in LPS-challenged mice was suppressed by prior administration of these analogues as well as LPS. Prior treatment of murine macrophages with the substances suppressed LPS-stimulated TNF-alpha production in the culture supernatant and TNF-alpha mRNA expression in the cells as well. Lethal toxicity of TNF-alpha in GalN-sensitized mice was effectively suppressed by prior treatment with LPS, GLA-60 and GLA-69 but not by GLA-58. This protective effect was suggested to be mediated by endogenous TNF-alpha, which was induced by prior treatment with the effective substances, because either neutralization of endogenously induced TNF-alpha activity with an antibody or deletion of its induction by using LPS-resistant C3H/HeJ mice reduced the protective effect, and a detectable amount of TNF-alpha was produced by stimulating macrophages with the effective substances but not with GLA-58. These results indicated that multiple regulation steps (one is prior to and the others are following TNF-alpha production) are participating in the tolerance induction by LPS and some lipid A analogues and that GLA-58 is a characteristic compound which induces the tolerance by only blocking the step prior to TNF-alpha production.

Genetic instability of human cells with DNA related to human retrovirus

To elucidate the role of HTLV-I in human neoplasia, DNA was extracted from tumor tissues, cultured cells, and/or sera from 20 HTLV-I seropositive and from 10 seronegative cancer patients, subjected to PCR-PAGE, and analyzed by Southern hybridization. HTLV-I related sequences were detected in tumors of the seropositives with different types of cancer. In the seronegatives, gag related sequences were detected in some tumors, whereas LTR related sequences were detected in only uterus carcinoma and tax related sequences in none of tumors examined. These sequences were detected in tumor cells as well as lymphoid cells by in situ hybridization. Some of these sequences were also detected in cultured fibroblasts derived from ATL patients. Cultured normal human lymphocytes grew continuously in conditioned media following HTLV-I infection, and transformed on exposure to carcinogens. Chromosome changes in transformed cells appeared clustering to chromosomes abnormalized on HTLV-I infection. The frequency of abnormal chromosomes in lymphocytes was significantly higher in the seropositives and in their family members than in seronegative normal donors. The frequency increased with advancement of host age in the seropositives but not in the seronegatives. These findings indicate that some individuals carry HTLV-I related sequences that may be derepressed by host aging and resulted in increasing genetic instability of host cells rendering them increasingly susceptible to carcinogens.

Significance of VLA-4 and LFA-1 expressions in neoplastic follicle formation and its deterioration in B-cell non-Hodgkin's lymphomas

In an attempt to determine the roles of adhesion molecules in the formation and deterioration of neoplastic follicles, we used flow cytometry to investigate how strongly neoplastic B-cells express VLA-4 alpha and LFA-1 alpha on their surfaces. Neoplastic and normal B-cells were taken from 24 patients with B-cell non-Hodgkin's lymphomas (B-NHL) and 6 with B-cell chronic lymphocytic leukemia (B-CLL). The expression intensities of the adhesion molecules were graded as follows: (-), (+), (+2) and (+3). Normal B-cells expressed those molecules with an intensity of (+2). The data for VLA-4 alpha expression were as follows: follicular B-NHL [10/11; (+2) and 1/11; (+)], partially follicular [5/5; (+)], diffuse [8/8; (+)] and B-CLL [6/6; (-)]. Those for LFA-1 alpha were as follows: follicular B-NHL [7/11; (+2), 4/11; (+)], partially follicular [3/5; (+2), 2/5; (+)], diffuse [3/8; (+2), 5/8; (+)] and B-CLL [3/6; (+), 3/6; (-)]. These results suggest that VLA-4 molecules expressed on neoplastic B-cells may be involved closely in the formation and deterioration of neoplastic follicles, although the expression of LFA-1 molecules seems to play only a minor part in such events.

Primary chemotherapy for children with rhabdomyosarcoma of the 'special pelvic' sites: is preservation of the bladder possible?

Twenty-one children with rhabdomyosarcoma involving the "special pelvic" sites, defined as such occurring in the bladder, prostate, vagina and uterus, were treated with primary surgery between 1969 and 1977, and with primary chemotherapy beginning in 1978. Among 11 patients in the latter group who were placed in Clinical Group III (according to the classification of the US Intergroup Rhabdomyosarcoma Study (IRS), six showed partial response (PR) and underwent tumorectomy by radical surgery an average of 6 months after the start of treatment, and three showed complete response (CR) and were treated with further chemotherapy in the hope that cystectomy could be avoided. However, in the latter group, the tumor recurred (39 months, 35 months, and 27 months later), and all eventually underwent total cystectomy. Seven of the nine long-term survivors underwent total cystectomy and have premanent urinary-cutaneous stomas. Two had tumor-free bladders, but function was impaired in one because of the effect of irradiation. Normal function was preserved in only one patient in the series, whose tumor was located at the dome of the bladder. To preserve bladder function in children with rhabdomyosarcoma in these sites, more effective forms of chemotherapy will be required.

Dirofilaria immitis: a large-scale purification method and partial characteristics of a superoxide dismutase from adult worms

A superoxide dismutase (SOD) from adult worms of Dirofilaria immitis was purified using ethanol-chloroform and acetone treatment, DE 52 cellulose, and Sephadex G-75 gel chromatography to obtain a 677-fold purification and a specific activity of 5483 units/mg of protein. The purified SOD was essentially homogeneous as judged by polyacrylamide gel electrophoresis in the presence of sodium dodecyl sulfate and composed of two identical 18.5 kDa subunits. The purified SOD was inactivated completely by 3 mM potassium cyanide, and reduced to about 18% of the initial activity by incubation at 100 degrees C for 10 min and to 28% by treatment with 2% SDS. This means that D. immitis SOD differs markedly from the mammalian Cu/Zn SOD, although it is indeed a Cu/Zn SOD. Atomic absorption spectrometry revealed the presence of 0.80 mole of Cu and 0.78 mole of Zn per mole of subunit. The enzyme consisted of 22.6% acidic and 11.9% basic amino acids. No free amino acid was detected in the SOD by N-terminal amino acid sequencing.

Isolation of intact transition protein 1 and 3 from boar late spermatid nuclei

Boar transition protein 1 and 3 were extracted with acid from the late spermatid nuclei, separated from the TP-degrading proteases by ion-exchange chromatography on Fractogel EMD SO3- 650 (M), and further purified by HPLCs on Diol-120 and on Hitachi #3057, respectively. The circular dichroic spectra of the transition proteins with and without dithiothreitol showed that they have beta-form predominantly. Although sodium dodecyl sulfate partially induced helical structure, the beta-form was considerably retained. These indicate that the transition proteins have a structure-forming potential for the beta-structure.

[Role of postoperative irradiation for carcinoma of the uterine cervix: multivariate analysis of prognostic factors and patterns of failure]

We retrospectively analyzed the patterns of recurrence in 48 patients who underwent postoperative irradiation following surgery for carcinoma of the uterine cervix. The end points of pelvic control, distant metastases and disease-free survival were analyzed for parameters including FIGO stage, nodal status, degree of stromal invasion, histology and tumor size. Univariate and multivariate analyses showed that some prognostic parameters had little influence on pelvic control rate, but had a marked impact on the incidence of distant metastases and disease-free survival rate. These results suggest that postoperative irradiation improves pelvic control rate, but has little therapeutic benefit in preventing distant metastases or improving survival rate. In conclusion, we should give more consideration to adjuvant systemic therapy in addition to postoperative irradiation for high-risk patients.

[Successful patch angioplasty for the right coronary artery dissection following selective coronary perfusion]

A case of successful patch angioplasty for the right coronary artery (RCA) orifice dissection following selective coronary perfusion is reported. A 56-year-old woman who had mitral restenosis, aortic stenosis, and atrial fibrillation with bradycardia-tachycardia syndrome was referred to our hospital for operation. The operation, which contained aortic valve replacement and mitral commissurotomy, was performed with hypothermic cardiopulmonary bypass and crystalloid cardioplegic arrest. The ascending aorta was opened, and selective coronary perfusion was performed. The right coronary cannula was difficult to insert and dislodged several times. At the second infusion of the cardioplegic solution, the right coronary orifice and ascending aortic wall was dissected. The dissection extended to the proximal RCA. The aortotomy was extended into the RCA beyond its orifice. The Xenomedica pericardial patch was used to enlarge the diameter of the RCA with closing the dissected cavity. Then the patch was brought onto the side of the aorta and the aortotomy was closed in the usual manner. Post operative coronary angiography revealed widely patent RCA orifice and good runoff. Two years after operation the patient is free of angina with unlimited physical activity.

The amino acid sequence and phosphorylation sites of a boar transition protein 1

Boar transition protein 1 was extracted with acid from the testes, purified by chromatographies on CM-Sephadex C-25 and Sephadex G-50, and reduced and carboxymethylated. The modified protein was purified by HPLC on Nucleosil 300 7C18. The primary structure of the protein was determined by automated Edman degradation of the C-terminal peptide of the BrCN-cleaved protein and of the whole protein, and by carboxypeptidase digestion of it. The study of phosphorylation sites showed that Ser36 and Ser39 in the very conserved sequence 29-42 were partly phosphorylated, suggesting the involvement of this region in the interaction with DNA.