-Rejection of an allogeneic bone marrow graft following successful treatment of severe graft-versus-host disease (GVHD)

A 38-year-old female with acute myelogenous leukemia (M2) received an allogeneic bone marrow graft from an HLA-DR one locus-mismatched sister during the first remission. The conditioning regimen consisted of busulfan and cyclophosphamide. Acute graft-versus-host disease (GVHD) developed on day 11 after transplantation. Although the GVHD was successfully treated with methylprednisolone, peripheral blood neutrophils that had begun to increase disappeared in association with improvement of the GVHD and graft rejection was eventually diagnosed. The second bone marrow transplantation from the same donor ended up with engraftment failure. She died of sepsis due to Candida albicans following the development of Epstein-Barr virus-associated B-lymphoproliferative disorder. The clinical course of this patient indicates that successful therapy of severe GVHD with methylprednisolone may lead to marrow graft rejection.

Evaluation of sialyl Lewisx antigen in the skin and the sera of patients with psoriasis vulgaris

The roles of sialyl-Lewisx antigen were evaluated in the pathogenesis of psoriasis. Sialyl-Lewisx expression was investigated immunohistochemically in the epidermis of normal human skin and erythematous lesional skin of psoriasis vulgaris by avidin-biotin-peroxidase complex procedures. A few sialyl-Lewisx positive dendritic cells were detected in the epidermis of normal human skin. In 7 out of 9 cases of psoriasis vulgaris, the number of sialyl-Lewisx-positive epidermal dendritic cells increased in the erythematous lesion over the adjacent normal skin; there were no marked changes in the numbers of CD1a-positive cells in the epidermis between the two skin types. In the double immunofluorescence studies, more than half of the sialyl-Lewisx-positive epidermal cells in psoriatic erythema were stained with a monoclonal Lag antibody that specifically reacts with Birbeck granules and related structures of human Langerhans cells. Furthermore, we determined the changes in serum levels of sialyl-Lewisx antigens in patients with psoriasis. Although levels in the sera were not significantly elevated over those of controls, the increases correlated with the degree of disease activity. These findings suggest that sialyl-Lewisx antigen is possibly involved in the development of psoriasis.

c-KIT receptor expression in cutaneous malignant melanoma and benign melanotic naevi

To investigate the role of c-KIT receptor in melanocytic tumour development and progression, we analysed the expression and localization of c-KIT by immunohistochemistry and Western blotting. In contrast to the positive staining shown by melanocytes and naevus cells in the epidermis of common naevi (n=20), all dysplastic naevi (n=13) were negative, as were dermal melanocytic cells of blue naevi (n = 4) and common naevi (n = 26). Three out of four superficial spreading melanomas lost c-KIT expression both in the epidermal and dermal parts, while nodular melanomas showed no expression of c-KIT except in partially positive cells, and six out of seven metastatic melanomas were negative. In acral lentiginous melanomas (n = 8), in contrast to other types of melanoma, all cases with melanoma cells growing basally in the epidermis showed strong c-KIT positivity, but melanoma cells growing at the upper layers of the epidermis and vertically into the dermis lost c-KIT expression. Using the Western blot method on cultured pigment cells, human epidermal melanocytes, junctional naevus cells and one out of three metastatic melanoma cell lines showed 125 and 145 kDa bands corresponding to c-KIT, whereas dermal naevus cells did not. These results suggest that dysplastic naevi are distinct from ordinary naevi in terms of c-KIT expression and that basally growing cells in acral lentigenous melanomas could be at an initial stage of tumour progression, before c-KIT loss occurs.

Granulosa cells express integrin alpha 6: possible involvement of integrin alpha 6 in folliculogenesis

To identify differentiation antigens of granulosa cells, we have raised two monoclonal antibodies against porcine granulosa cells (POG-2 antibody) and human granulosa cells (OG-1 antibody). Analysis of N-terminal amino acid sequences of purified OG-1 and POG-2 antigens revealed that they were identical to human integrin alpha 6 and its porcine homolog, respectively. An immunohistochemical study showed that integrin alpha 6 was highly expressed on granulosa cells in preovulatory follicles in the human ovary, whereas it was highly expressed on granulosa cells in small follicles in the porcine ovary. As a common characteristic of integrin alpha 6 expression in both ovaries, granulosa cells located in inner layers, which are not in contact with the basal lamina, expressed integrin alpha 6 on the cell surface. This expression profile suggests that the interaction between integrin and extracellular matrices occurs in the granulosa cells located in inner layers. This cell surface interaction is reported to modulate soluble signals to the cells. Since the expression of integrin alpha 6 on inner-layer granulosa cells is related to stages of differentiation, this interaction may be involved in folliculogenesis.

Response to immunosuppressive therapy and an HLA-DRB1 allele in patients with aplastic anaemia: HLA-DRB1*1501 does not predict response to antithymocyte globulin

HLA-DRB1*1501, a subtype of HLA-DR2, has been shown to be closely associated with a good response to cyclosporine (CyA) therapy in patients with aplastic anaemia (AA). To determine whether this DRB1 allele can also predict a response to antithymocyte globulin (ATG) therapy in AA patients, we analysed the results of HLA-DRB1 typing in 59 Japanese patients who received ATG within 2 years after diagnosis of AA and also in 52 patients treated with CyA. All patients were divided into three groups: those with DRB1*1501, those with DRB1*1502, and those without either of these two alleles (DR2-). The response rate to ATG in DRB1*1501+ patients (56%) was not significantly higher than that in DRB1*1502+ patients (47%) and in the other DR2- patients (54%). In contrast, the response rate to CyA therapy in DRB1*1501+ patients (92%) was significantly higher than that in the DRB1*1502+ (41%) and in DR2- patients (57%). Multivariate analysis revealed that possessing DRB1*1501 was an independent factor significantly predictive of a good response to CyA. These results indicate that although identifying the DRB1*1501 allele in AA patients prior to therapy is predictive of a good response to CyA therapy, it does not have a predictive value for ATG therapy.

Human betacellulin, a member of the EGF family dominantly expressed in pancreas and small intestine, is fully active in a monomeric form

Betacellulin (BTC) was found to be expressed mainly in human pancreas and small intestine. This finding suggests that BTC possesses some specific function distinguished from the other members of epidermal growth factor (EGF) family. To clarify this function, the released form of human BTC has been expressed in E.coli, purified, and characterized. The recombinant human BTC was produced as an inclusion body. This material was dissolved in guanidine-HCl under reducing conditions, refolded, and purified through sequential liquid chromatography. Purified BTC was electrophoresed under reducing conditions and a molecular size of 18 kDa was determined, which is the supposed size of a dimer of the peptide. However, chemical analysis failed to show a covalently linked dimer. The molecular mass of BTC analyzed by mass spectrometry revealed it to be 9 kDa, which is consistent with theoretical value for a monomer. Recombinant BTC showed growth promoting activity for mouse fibroblasts and rat aortic smooth muscle cells which was equivalent to EGF On the other hand, BTC was found to exhibit a growth inhibitory effect on the cells overexpressing EGF receptor.

Increased tenascin expression is an early feature of the development of transplant renal arteriopathy in humans

Transplant renal arteriopathy (TRA) is a major obstacle to the long-term survival of human renal allografts. Tenascin (TN) is an extracellular matrix glycoprotein associated with cell growth and differentiation. We investigated TN expression in intrarenal arteries with TRA, in association with cellular components, with phenotypic expression of smooth muscle cells (SMC) and with fibronectin expression. Ten renal allografts that had been removed due to rejection were available. Monoclonal antibodies against SMC, macrophages, T cells, B cells, fibronectin, and TN were used. In the early stages, medial SMC showed a de-differentiated phenotype and the neointima consisted largely of T cells and macrophages. At these stages, increased expression of TN was observed in the media. In later stages, the neointima consisted almost entirely of SMC of a differentiated phenotype and no TN expression was found. Up-regulation of TN may play a role in the migration and phenotypic modulation of SMC at an early stage of TRA in humans.

Experimental and clinical studies on balloon laserthermia using Nd: YAG laser for uterine endometrial cancer

BACKGROUND AND OBJECTIVE

No conservative therapy for endometrial cancer exists. We therefore evaluated the new balloon laserthermia for such cases.

STUDY DESIGN/MATERIAL AND METHODS

Experimental and clinical study. We examined experimentally porcine kidney and stomach, human resected uterus and clinically on 12 patients with endometrial cancer and two patients with hyperplasia.

RESULTS

Temperatures were safely kept at the balloon surface. Laser irradiation should be performed for at least 10-15 min, 65-70 degrees C to produce a suitable degeneration, experimentally. Clinically, necrosis and degeneration to a depth of 4-6 mm was histologically observed. Eight patients with carcinoma and hyperplasia for which laserthermia was effective showed that the surface of cancer was smooth and the depth of invasion was in most cases up to 1/4 of muscle layer.

CONCLUSION

Balloon laserthermia may be effective in early endometrial cancer or precancerous lesions. Its clinical usefulness should be investigated further.

Preoperative thermochemotherapy of oral cancer using magnetic induction hyperthermia (Implant Heating System: IHS)

Eight patients with primary cancer of the oral cavity were preoperatively treated by combined treatment with hyperthermia and chemotherapy. They received two courses of chemotherapy, which included intra-arterial infusion of 100 mg of cisplatin (CDDP) and 25 mg of peplomycin (PEP) via the superficial temporal artery. The patients also received interstitial hyperthermia for 45 min once a week using the Implant Heating System (IHS) with chemotherapy. IHS consists of ferromagnetic implant, induction coil and generator to produce high frequency magnetic field. The ferromagnetic implant is made of Fe-Pt alloy (Fe: 73%, Pt: 27%), and has a Curie temperature of 68 degrees C. As a result, clinical complete response (CR) was observed in seven patients and partial response (PR) in one, and postoperative pathological examination showed no residual tumour cells in any specimen. Combined interstitial hyperthermia by IHS and chemotherapy is thus found to be an effective therapeutic method for treating oral cancers.

Comparison of p53 gene abnormalities in bilateral and unilateral breast cancer

BACKGROUND

The results of recent studies have suggested that p53 gene abnormalities are associated with carcinogenesis in several neoplasms. It is believed that bilateral breast carcinomas develop as a result of a different carcinogenetic mechanism and genetic environment from those of unilateral lesions.

METHODS

p53 Gene abnormalities in bilateral primary breast cancer were detected by polymerase chain reaction-single strand comformation polymorphism (PCR-SSCP) analysis. A total of 76 paraffin embedded tissue specimens from 38 patients with bilateral primary breast cancer were examined, and 62 patients with unilateral breast cancer were analyzed as control subjects. The bilateral tumors were defined as primary, based on clinical parameters and the presence of an intraductal component. There were 13 patients with synchronous bilateral breast cancer and 25 with metachronous bilateral breast cancer.

RESULTS

p53 Gene abnormalities were detected in 50% of the bilateral and 25.8% of the unilateral cases, and the difference was significant (P < 0.01, chi-square test). Abnormalities were detected in 56% of the metachronous cases, representing a much higher incidence than that of the unilateral cases (P < 0.001, chi-square test). The incidence of p53 gene abnormalities in the first and second tumors of the metachronous cases was 44% and 68%, respectively. The percentage of patients with a p53 gene abnormality and positive family history was higher for those with bilateral than with unilateral breast cancer (P < 0.01, chi-square test).

CONCLUSION

These findings indicate that the genetic changes and mechanism of carcinogenesis in bilateral and unilateral breast cancer are different.

[Midterm result of free arterial graft for myocardial revascularization]

Free arterial grafts has been used as grafts for coronary artery bypass grafting (CABG) since April 1993 in our unit and midterm patency was confirmed by coronary angiogram in 32 patients. Of 32 free arterial grafts. 23 right internal thoracic artery grafts (RITAG), 7 gastroepiploic artery grafts (GEAG) and 2 left internal thoracic artery grafts (LITAG) were placed to 38 coronary arteries including 6 grafts for sequential bypass. 20 grafts were placed in the left circumflex artery. 11 to the diagonal branch, 5 to the left anterior descending artery and 3 to the right Free arterial grafts has been used as grafts for coronary artery bypass grafting (CABG) since April 1993 in our unit and midterm patency was confirmed by coronary angiogram in 32 patients. Of 32 free arterial grafts. 23 right internal thoracic artery grafts (RITAG), 7 gastroepiploic artery grafts (GEAG) and 2 left internal thoracic artery grafts (LITAG) were placed to 38 coronary arteries including 6 grafts for sequential bypass. 20 grafts were placed in the left circumflex artery. 11 to the diagonal branch, 5 to the left anterior descending artery and 3 to the right coronary artery. Coronary angiography later than 6 months after operation revealed the patency rate of 100% for LITAG and RITAG and 81.8% for GEAG. In total 36 free arterial graft remained patent and patency rate was 94.7% and the result was comparative to the midterm patency of in situ arterial graft in our series. Free arterial grafts can be expected to offer excellent long term patency and expand the indication of arterial grafts to CABG.

Contraction potency of hypertrophic scar-derived fibroblasts in a connective tissue model: in vitro analysis of wound contraction

Many investigators have reported that collagen gel contraction reflects the mechanism of wound contraction. By using a connective tissue model (CTM) of collagen gel lattice, we analyzed the contraction potency of fibroblasts that had been obtained from hypertrophic scar, normal skin, and normal oral mucosa. We then tried to analyze the mechanism of CTM contraction by immunofluorescent microscopic and transmission electron microscopic examinations. Hypertrophic scar-derived fibroblasts in CTM possessed the greatest contraction potency and the shortest lag time when compared with those of normal skin and normal oral mucosa-derived CTMs. It became clear that the initial contractive degree of CTM was closely related to morphological changes of fibroblast cells into bipolar and elongated shapes. Hypertrophic scar-derived fibroblasts elongated their processes faster, and their intracellular actin filaments were more numerous than those of normal fibroblasts. We believe that the hypertrophic scar-derived CTM is a useful pathological model for the research of wound contraction and hypertrophic scar formation.

The clinical and histopathological effects of combined chemotherapy using cisplatin and peplomycin to treat cancer of the tongue

Combined chemotherapy (PP therapy) using cisplatin (CDDP) and peplomycin (PEP) was performed as induction chemotherapy for 31 patients with cancer of the tongue, and the clinical and histopathological effects were investigated. As the primary clinical effect, complete response (CR) was observed in three cases, partial response (PR) in 20 cases, minor response (MR) in six cases and no change (NC) in two cases, with a clinical response rate of 74.2%. The histopathological effects of the chemotherapy in the following cases showed these histological Grades: 0 or I in four cases, IIa in 12 cases, IIb in eight cases, III in six cases and IV in one case. Fifteen of the 31 patients who received PP therapy showed a histological Grade of IIb or better, representing 48.4% of the histopathological response rate. With regard to the mode of invasion of the tumor, the histopathological response rate was 90.0% in patients with invasive Grades 1 and 2, 41.7% in those with invasive Grade 3 and 16.7% in those with invasive Grade 4C. There were no patients with invasive Grade 4D in whom the therapy was histopathologically effective. In other words, the histopathological effect significantly decreased as the invasive Grade increased. With regard to the relationship between clinical effects and histopathological effects, there was one CR patient who showed a histological Grade of IIa. Thus, it is noteworthy that clinical effects were not necessarily consistent with post-chemotherapeutic histopathological effects.

Leiomyosarcoma of the maxillary gingiva: a case report

An unusual case of leiomyosarcoma (LMS) of the maxillary gingiva is discussed here; this case presents a unique pattern of tumor growth and a long period between initial discovery and correct pathological diagnosis. The tumor was incompletely resected twice by a private dentist over a period of 3 years, with a clinical diagnosis of epulis, no pathological examination was conducted during this period. When it was finally removed, the tumor was very large (50 x 35 x 12 mm in size and 18 g in weight), consisting of an easily hemorrhagic mass originating in the gingival mucosa with the growth pattern of a polyp. Following an extensive surgical excision and a unilateral radical neck dissection, the patient has been free of LMS for 8 years. In light of this case, we strongly emphasize the importance of conducting a pathological examination, even though clinical examination seems to indicate a diagnosis of epulis or granulation. In this way, the presence of LMS can be ascertained in a timely manner with better prognosis for treatment and recovery.

Assessment of the effects of aging and medication on salivary gland function in patients with xerostomia using 99mTC-scintigraphy

To examine the effect of aging and medication on xerostomia, the salivary gland function was evaluated in 20 patients with xerostomia using 99mTc-scintigraphy and the measurement of unstimulated whole saliva (USWS). All of the patients showed USWS volume of less than 2ml/10min. The patients were divided into 2 subgroups based on age (under 65 and 65 and older) and medication status (patients who were on medication which reduced salivary secretion and patients who were not on such medication). The scintigraphic results, such as the maximum radioisotope (RI) count, RI secretion velocity and the volume of USWS, were compared between the subgroups. The maximum RI count and the RI secretory velocity in the submandibular gland and the volume of USWS revealed significantly different functional disturbances between relatively younger patients (under 65) and older patients (65 and older). There was no difference when the scintigraphic results and the volume of USWS measurements in medicated patients were compared with the results of similar tests performed on non-medicated patients. When the medicated and non-medicated groups were separated by age, an increase in age still diminished the volume of USWS in medicated patients. This result might be related to an organic change in the submandibular gland in older patients which was suggested by the scintigraphic results.

Primary structures and properties of two related forms of aryl sulfotransferases in human liver

cDNAs and genes of ST1A2 and ST1A3 section were isolated from human liver cDNA and genomic libraries and shown to encode arylsulfotransferases. Studies on their mRNAs and proteins expressed indicate the existence of two distinct phenol-sulfating enzymes which are involved in the metabolic activation of carcinogenic arylamines in human livers.

The potential of oral mucosal cells for cultured epithelium: a preliminary report

We have developed a method to fabricate cultured epithelium for skin repair using mucosal cells. We grafted this epithelium in six cases. The site where the mucosal epithelium was transplanted keratinized normally within 4 weeks and formed normal skin. Mucosal epithelial cells have many advantages over skin epidermal keratinocytes: (1) Mucosal epithelial cells grow faster than skin keratinocytes. (2) Cultured epithelial sheets formed using mucosal cells remain viable for at least 14 days in vitro. (3) The oral cavity is a suitable location to take a tissue segment because scar due to biopsy is inconspicuous. Therefore, mucosal epithelial cells are a potential new source of cells for cultured epithelial graft.

[Xeroderma pigmentosum]

Xeroderma pigmentosum (XP), an autosomal recessive disorder, is characterized by extreme sensitivity to sun exposure, a high incidence of skin cancer and frequent neurological abnormalities. Cells from XP patients of seven complementation groups (A-G) have defects in the nucleotide excision repair of UV damage, whereas the defect of another type, the XP variant, is not yet known. Recent discoveries of causative genes of XP have uncovered the molecular mechanisms of nucleotide excision repair. The analysis of gene mutation in XPA gene made a diagnosis of patients and carriers quicker and easier. Further, a relationship between the type of XPA gene mutation and clinical severity has also been uncovered. By analysing skin cancers developed on XP patients, the representative of UV-induced skin cancers, the molecular bases of UV skin carcinogenesis have also been rapidly discovered.

Correlation between a sandwich ELISA and an in-vitro bioassay for erythropoietin in human plasma

A sandwich-type enzyme-linked immunosorbent assay (ELISA) for human erythropoietin (EPO) using two anti-EPO monoclonal antibodies has been compared with an in-vitro EPO bioassay based on CFU-E colony formation in fetal mouse liver cell cultures. In normal subjects and non-uraemic anaemic patients the plasma EPO values estimated with the ELISA correlated well with those by the bioassay, and also inversely with the values of blood Hb, PCV and RBC counts. Dose-response curves for plasma and standard recombinant human EPO in the ELISA were parallel to each other. These results further confirm the validity for the ELISA in measuring circulating human EPO.

[Study on conservative treatment of retinoblastoma--effect of intravitreal injection of melphalan on the rabbit retina]

Effects of an intravitreal injection of melphalan on the electroretinogram and on the retinal structure were studied in albino rabbits to establish the non-toxic dose for its intravitreal use. The a-wave, the b-wave, the c-wave, the oscillatory potential and the retinal structure remained unchanged after 10-micrograms injection, but moderately changed after 20-micrograms injection and greatly deteriorated after 90-micrograms injection. A 10-micrograms injection is equal to an intravitreal concentration of about 5.9 micrograms/ml, if evenly diffused in the rabbit vitreous. Considering that colony formation of in vitro retinoblastoma cells is completely suppressed by melphalan at 4 micrograms/ml concentration, an intravitreal application of melphalan could be used as a non-surgical treatment for retinoblastoma.

Purification and some properties of six chitinases from Aeromonas sp. no. 10S-24

Six chitinases were purified from a culture supernatant of Aeromonas sp. no. 10S-24 by ammonium sulfate precipitation, DEAE-Sephadex A-50, Butyl-Toyopearl 650M, and chromatofocusing. These enzymes were most active at pH 3.5-4.5 and the optimum temperature were 50 degrees C. The molecular weights of the enzymes were 89,000 to 120,000 from SDS-polyacrylamide gel electrophoresis. N-Terminal amino acid sequences of the enzymes were similar to that of chitinase I.