Amyloid-beta deposition in skeletal muscle of transgenic mice: possible model of inclusion body myopathy

Inclusion body myopathy is a progressive muscle disorder characterized by nuclear and cytoplasmic inclusions and vacuolation of muscle fibers. Affected muscle fibers contain deposits of congophilic amyloid, amyloid-beta immunoreactive filaments, and paired helical filaments, all of which are pathological hallmarks of Alzheimer's disease in brain. Accumulations of amyloid-beta and its precursor are thought to play important roles in the pathogenesis of both inclusion body myopathy and Alzheimer's disease. Overexpression of mutant forms of beta protein precursor in transgenic mice by neuron-specific promoters has been reported to cause amyloid deposits in the brain. Here we report that overexpression in transgenic mice of the signal plus 99-amino acid carboxyl-terminal sequences of beta protein precursor, under the control of a cytomegalovirus enhancer/beta-actin promoter, resulted in vacuolation and increasing accumulation of the 4-kd amyloid-beta and the carboxyl-terminus in skeletal muscle fibers during aging. These deposits in transgenic muscle only rarely showed Congo red birefringence. Thus, overexpression of part of beta protein precursor in transgenic mice led to development of some of the characteristic features of inclusion body myopathy. These mice may be a useful model of inclusion body myopathy, which shares a number of pathological markers with Alzheimer's disease.

Sympathetic reinnervation demonstrated on serial iodine-123-metaiodobenzylguanidine SPECT images after cardiac transplantation

The transplanted heart is without autonomic nervous control in the early postsurgical period. We present here a case of cardiac transplantation in which 123I-metaiodobenzylguanidine (MIBG) SPECT and an exercise-loading test were used to monitor the sympathetic reinnervation. The distribution of myocardial 123I-MIBG uptake extended with time from 1 to 2 yr after surgery. However, functional improvement, estimated by the heart rate response to exercise, was not discernable during this period. The findings in this case suggest the feasibility of 123I-MIBG SPECT imaging in the serial monitoring of sympathetic reinnervation after transplantation and that scintigraphic evidence of reinnervation precedes functional recovery.

Impaired regional fatty acid uptake and systolic dysfunction in hypertrophied right ventricle

Little information is available regarding the determinants of systolic contractile function of the hypertrophied right ventricle (RV). The purpose of this study was to clarify the relationship between myocardial metabolism and contractile function in the hypertrophied RV due to pulmonary hypertension (PH).

METHODS

Iodine-123-labeled 15-(p-iodophenyl)-3-(R,S)-methylpentadecanoic acid (BMIPP) and 99mTc-sestamibi (MIBI) SPECT were performed to calculate the RV-to-left ventricle (LV) tracer uptake ratio (RV/LV) in 21 patients with PH (6 with primary PH and 15 with chronic thromboembolic PH). The patients also underwent electron-beam CT to assess RV ejection function (RVEF) and percentage systolic wall thickening (%SWT) and right heart catheterization to measure mean pulmonary arterial pressure (mPAP).

RESULTS

There were significant positive correlations between mPAP and MIBI-RV/LV (r = 0.89, p < 0.001) and between mPAP and BMIPP-RV/LV (r = 0.86, p < 0.001). However, 8 patients showed lower BMIPP-RV/LV than MIBI-RV/LV, indicating the impairment of myocardial fatty acid uptake in the RV. These patients had lower RVEF and %SWT compared to those with normal myocardial fatty acid uptake (RVEF = 28% +/- 10% compared to 40% +/- 9% and %SWT = 33% +/- 27% compared to 74% +/- 30%, respectively; p < 0.05 for both comparisons). Although mPAP did not differ between the groups, the RVEF-mPAP and %SWT-mPAP regression lines drawn from the patients with impaired myocardial fatty acid uptake were located below the lines from the patients with normal myocardial fatty acid uptake, suggesting disproportionately decreased RV myocardial contractility for a given mPAP in patients with impaired myocardial fatty acid uptake. The patients with the impaired fatty acid uptake in the RV had a significantly higher death rate (log-rank test, p < 0.05).

CONCLUSION

The results from this preliminary study suggest that myocardial fatty acid uptake is impaired in the failing hypertrophied RV due to PH.

DNA damage induces p21 protein expression by inhibiting ubiquitination in ML-1 cells

We previously reported that deferoxamine, an iron chelating agent, induced p53 and cell accumulation in the G1 phase of ML-1 cells in the same way as the DNA damaging agent, etoposide. Etoposide treatment increased expression of the p21 gene, a cyclin kinase inhibitor, at both the mRNA and protein levels. However, deferoxamine treatment only increased the p21 mRNA level without the appearance of a detectable protein product. A substrate for cyclin kinase, pRB, was unphosphorylated by etoposide treatment, but remained unaffected by deferoxamine, indicating that p21 was functional after etoposide, but not after deferoxamine treatment. Therefore, in the present study, we investigated the involvement of the ubiquitin proteasome pathway in post-transcriptional regulation of p21. By the addition of lactacystin, a proteasome inhibitor, to deferoxamine treatment, the level of unubiquitinated p21 protein product was similar to that induced by etoposide treatment, and the ubiquitinated p21 bands became apparent. After etoposide treatment, the level of ubiquitinated p21 was diminished and a high level of unubiquitinated p21 expression was observed. We concluded that (1) efficient expression of p21 protein requires inhibition of the ubiquitin-proteasome pathway, and (2) DNA damage inhibits the ubiquitination of p21.

[Occurrences of penicillin-binding protein 2B gene in clinically isolated penicillin-resistant Streptococcus pneumoniae]

We analyzed 88 strains of Streptococcus pneumoniae (S. pneumoniae) isolated in Showa University Hospital from June 1995 to July 1996. The ratios of antibiotic resistance were 39% to penicillin G, 50% to erythromycin, and 2% to imipenem. No resistant to cefotaxime and ofloxacin was observed. Thirty-four strains (39%) were considered to be penicillin-resistant S. pneumoniae (PRSP) strains (MIC of penicillin G > or = 0.5 microgram/ml), according to the breakpoint determined by the Japanese Working Group for Penicillin-Resistant Streptococcus pneumoniae. The ratio of PRSP was higher in S. pneumoniae isolated from inpatients (25/47) when compared to that from outpatients. By PCR analysis, DNA regions of autolysin were amplified in all the 88 strains, confirming that the isolates were S. pneumoniae. Penicillin-binding protein 2B (PBP2B) class B region was positive in 32 strains, and PBP2B class A was in 2 strains. Twenty eight of 34 strains of PRSP contained the PBP2B class B gene. In the remaining six PRSP strains, neither the PBP2B class A nor B region was amplified. The PBP2B class B region was detected as a 180-kb fragment of SmaI digestion of S. pneumoniae DNA by Southern blot analysis, confirming that the detection of PBP2B class B gene by PCR is reliable. We concluded that the PBP2B class B gene is considered to be a major gene responsible for phenotypic resistance of PRSP. We performed genotyping by SmaI digestion pattern using pulsed field gel electrophoresis. No identical pattern was observed in isolates from inpatients, suggesting that apparent nosocomial infection of S. pneumoniae was negligible.

Iodine-123-iomazenil and iodine-123-iodoamphetamine SPECT in major cerebral artery occlusive disease

Iodine-123-iomazenil (IMZ) is a SPECT ligand for central-type benzodiazepine receptors, which are located only on neurons. We evaluated the feasibility of using IMZ SPECT for identifying neuronal damage in patients with the chronic phase of thrombotic cerebral ischemia.

METHODS

We studied 15 patients with angiographically-confirmed unilateral severe occlusive lesions (occlusion or > 70% stenosis) in the carotid system. IMZ SPECT images obtained 180 min after injection of 167-222 MBq IMZ were analyzed. The regional cerebral blood flow and perfusion reserve were evaluated for comparison with IMZ SPECT findings, using the split-dose 123I-iodoamphetamine (IMP) SPECT method, coupled with intravenous injection of 1 g acetazolamide. On both SPECT images, the count ratio of the affected to the nonaffected whole MCA territory (A/NA ratio) and of the contralateral to the ipsilateral cerebellar cortex (C/I ratio) were determined.

RESULTS

The A/NA ratio with IMZ was significantly higher than that with IMP (94.5% +/- 6.2% versus 91.4% +/- 6.6%, p < 0.005), although a significantly positive correlation was found between these two ratios (r = 0.854, p < 0.0001). The C/I ratio with IMP was decreased significantly in 5 patients compared with that in normal subjects, whereas the C/I ratio with IMZ was decreased in only 1 patient. There was no significant correlation between the A/NA ratio with IMZ and the perfusion reserve in the affected MCA territory. In 2 of 5 patients with a decreased A/NA ratio (<90%) with IMZ, decreased blood flow with preserved perfusion reserve and cerebral hemispheric atrophy were observed, which suggested the influence of neuronal loss due to chronic ischemia.

CONCLUSION

These findings indicate that IMZ SPECT, which provides new information regarding neuronal damage after ischemic insult to the brain, is useful for evaluating thrombotic cerebral ischemia.

Induction of DNA fragmentation by nicotine in human myelogenous leukemic cell lines

The effect of nicotine, a component of tobacco, on the cytokine production and cell growth of various cultured cells was investigated. Nicotine did not stimulate, but rather inhibited the tumor necrosis factor production by human peripheral blood mononuclear cells at higher doses. Cytotoxic concentrations of nicotine did not induce the monocytic and granulocytic differentiation of human myelogenous leukemic cell lines (HL-60, ML-1). Nicotine induced internucleosomal DNA cleavage in these leukemic cell lines but not in human peripheral blood lymphocytes and polymorphonuclear cells. The fragmentation-inducing activity of nicotine was not prevented by simultaneous addition of ascorbic acid. Flow cytometry showed a slight increase in the number of G2 + M phase cells, before the appearance of the apoptosis peak. Nicotine transiently increased the intracellular calcium concentration to higher levels in leukemic cells than in normal leukocytes. These data suggest that the induction of DNA fragmentation requires elevation of intracellular calcium concentration above a certain threshold level.

Baumkuchen map analysis to detect postural cerebral hypoperfusion with upright 99Tcm-HMPAO brain SPET

We have evaluated a polar cortical flow Baumkuchen map (BK map), constructed from projection data by inwardly layering cortical flow stripes from the base to the apex, to detect postural cerebral hypoperfusion using 99Tcm-HMPAO brain SPET. A circular cortical perfusion outline was constructed from sinogram data at a 20% threshold; a ring was then formed by constructing an inner line with a radius equal to half that of the outer line. This ring on the transaxial image was superimposed onto the cortical image, then divided into 60 portions at 6 degrees intervals from the centre. The maximal number of counts per pixel within each sector was determined, translated into polar coordinate profiles and displayed as a polar map. We studied 11 patients with unilateral stenosis of the internal carotid artery or middle cerebral artery (MCA) and 7 patients without stenosis, using upright and supine (rest) 99Tcm-HMPAO brain SPET Cerebral perfusion was visibly altered on the BK maps of all 11 patients with arterial stenosis and on the transaxial images of 8 of them. A semi-quantitative analysis of the BK maps using a ratio of the counts in the regions of interest over the right and left MCA areas, showed that the mean of the ratios was significantly lower in the upright images than in the upright + rest and rest images (P = 0.0044 and 0.0033, respectively). Although the difference in the means of the ratios between the upright and upright + rest images was significant for both the BK map and transaxial image data (P = 0.0044 and 0.0051, respectively), the BK map was accurate in detecting changes in perfusion in the upright position. We conclude that BK map analysis is useful for detecting changes in patients examined using upright brain SPET.

Polymorphic tetranucleotide repeat site within intron 7 of the beta-amyloid precursor protein gene and its lack of association with Alzheimer's disease

Mutations found in the beta-amyloid precursor protein (APP) gene in a small subset of patients with Alzheimer's disease (AD) are associated with the development of the disease. Several lines of evidence indicate that specific isoforms of APP generated by alternative splicing of the primary transcript may contribute to the etiology of AD. One of the isoforms, APP695, lacks the Kunitz protease inhibitor (KPI) domain and is produced predominantly in neurons by skipping exon 7 of the APP gene. Previous studies imply that the controlling elements for exon 7 skipping exist in the flanking sequences of the exon. Therefore, we have sequenced the human intron 7 of the APP gene and found a polymorphic tetranucleotide (ATTT)n repeat site within the intron 7. In 183 genetically unrelated subjects (97 AD patients and 86 controls), we found four alleles by polymerase chain reaction (PCR) amplification of the repeat site. Although no particular alleles are associated with AD, this newly identified polymorphic site may be useful in other genetic analyses since preliminary evidence suggests allele frequency differences between African Americans and Caucasians.

Increased bone mineral turnover without increased glucose utilization in sclerotic and hyperplastic change in fibrous dysplasia

Fibrous dysplasia is a benign bone disorder. It is diagnosed by distinctive X-ray radiography, CT, and MRI findings. Although bone scintigraphy helps to identify the tumor origin according to accelerated bone turnover, the glucose metabolism in fibrous dysplasia has not yet been investigated. We reported a case of fibrous dysplasia in craniofacial bone which showed signs of the acceleration of bone mineral turnover without elevated glucose utilization by Technetium-99m-HMDP SPECT and Fluorine-18-FDG PET. We concluded that the growth of fibrous dysplasia needed the acceleration of bone mineral turnover without an increase in glucose metabolism.

Decreased hippocampal blood flow related to memory impairment after cardiovascular surgery: assessment by reconstructed SPECT parallel to the longitudinal axis of the hippocampal formations

Hippocampal damage has been linked to memory impairment. To clarify the relationship between decreased hippocampal blood flow and memory impairment in patients after cardiovascular surgery, the authors compared Tc-99m HMPAO SPECT findings and Mini Mental State Examination (MMSE) scores. Eight patients who had valve replacement, two who underwent aorto-coronary bypass, two who had aortic aneurysm replacement and one who had a ventricular septal defect closure were included in this study. Cerebral perfusion was estimated using reconstructed tomographic images, which were parallel to the longitudinal axis of the hippocampal formations. The hippocampal uptake ratios of Tc-99m HMPAO were calculated and normalized to that of the cerebellum. In three patients whose MMSE score decreased after surgery, the hippocampal uptake ratio was significantly reduced (0.69 +/- 0.09) compared with the remaining 10 patients whose MMSE scores did not decrease after surgery (0.91 +/- 0.02). These data suggest that SPECT imaging parallel to the longitudinal axis of the hippocampus is sensitive to decreased hippocampal blood flow, and decreased hippocampal blood flow is related to memory impairment in some patients after cardiovascular surgery.

Assessment of reperfused myocardium using a new ischaemia-avid imaging agent, technetium-99m HL91: comparison with myocardial glucose uptake

We evaluated the efficacy of a new ischae-mia-avid imaging agent, technetium-99m labelled 4,9-diaza-3,3,10,10-tetramethyldodecan-2,11-dione dioxime (99mTc- HL91) as a marker of myocardial viability in ischaemic and reperfused myocardium. The left coronary artery of rats was ligated for 15 or 60 min and released. The myocardium was reperfused for 60 min [stunned myocardium, or acute myocardial infarction (MI)] or 7 days (subacute MI). Thereafter, 99mTc-HL91 and carbon-14 2-deoxyglucose (DG) were co-injected 30 min before sacrifice. We evaluated the myocardial accumulation of 99mTc-HL91 and DG by dual-tracer ex vivo autoradiography. The uptake of each tracer in the myocardial region was normalized by that in the septum (control), and expressed as percent uptake (%HL or %DG, respectively). Individual hearts were also histopathologically examined. The %HL in the stunned myocardium (n = 8) and in the septum were identical (101%+/-15%, mean+/-SD, P = ns), whereas the %DG was significantly increased (149%+/-27%, P<0.05) compared with that in the septum. These results suggest that 99mTc-HL91 cannot visualize stunned myocardium, whereas DG can. In acute MI (n = 7), the %HL (423%+/-96%, P<0.005) and the %DG (318%+/-91%, P<0.001) in the non-infarcted area at risk were significantly augmented compared with those in the septum. The %DG (181%+/-17%) in the infarcted area was also augmented (P<0.001), whereas the %HL (106%+/-25%) in the infarcted area was identical to that in the septum (P = ns). These results indicate that 99mTc-HL91 detected viable myocardium in the area at risk. In subacute MI (n = 8), the%HL in the infarcted area (101%+/-45%) and in the septum was identical, whereas %DG (292%+/-57%) was significantly higher than that in the non-infarcted risk area or the septum (P<0.0001). These findings suggest that DG detected viable myocardium in the area at risk, but that 99mTc-HL91 was not retained. We conclude that 99mTc-HL91 is a potent marker of myocardial viability when used during the early acute phase after reperfusion.

[Usefulness of ECG-gated 99mTc-MIBI myocardial SPECT in the follow-up study of patients with acute myocardial infarction]

To clarify the background of the scintigraphic improvement in non-gated myocardial perfusion imaging for patients with acute myocardial infarction, we performed serial ECG-gated 99mTc-MIBI myocardial SPECT in 17 patients with acute myocardial infarction (AMI) receiving successful reperfusion therapy. ECG-gated myocardial SPECT and left ventriculography were performed at 1 week (acute phase) and 1 month (subacute phase) after the onset of AMI. Regional %uptake (regional count x 100/maximal count) was determined for each of 8 myocardial segments of the Bull's eye map. We analyzed the data in 53 AMI segments out of total 136 myocardial segments, on the non-gated (NG), end-diastolic (ED), and end-systolic (ES) images. In addition, the delta %uptake (%uptake in subacute phase--%uptake in acute phase) was also determined as an index representing the improvement of myocardial tracer uptake on each image. In 17 segments (group A) with wall motion recovery assessed by serial left ventriculography, the %uptake on the NG image was significantly improved (61.6 +/- 10.0 to 75.7 +/- 10.1, p < 0.0001). However, in 36 segments (group B) without wall motion recovery, the change of %uptake on the NG image was small. There was no significant change in the %uptake on the ED image in groups A and B. On the contrary, the %uptake on the ES image showed a significant increase in group A (58.4 +/- 11.8 to 68.9 +/- 11.8, p < 0.001), but did not in group B. Thus, this change on the ES image reflects the wall motion recovery. Furthermore, in group A, there was a significant correlation between the delta %uptake on the NG image and those on the ES image (p < 0.02), but was not between those on the NG and the ED images. Thus, the change in the %uptake on the NG image was more related to those on the ES image which is more affected by the change in regional wall motion than those on the ED image which reflects improved myocardial perfusion. These results suggest that ECG-gated myocardial 99mTc-MIBI SPECT is more useful to assess the serial change in myocardial perfusion and contraction than the conventional non-gated SPECT in the follow-up study of patients with AMI.

Alzheimer's disease and heparan sulfate proteoglycan

Alzheimer's disease (AD) is a debilitating neurodegenerative disorder. Cardinal histopathologic changes of AD are neurofibrillary tangles (NFTs) and deposits of beta-amyloid protein (A-beta) in the form of neuritic plaques (NPs). Several different mutations found in patients with familial AD have been demonstrated to increase A-beta production, resulting in a common pathological cascade of beta-amyloidosis in the brain. Heparan sulfate proteoglycan (HSPG) has been co-localized with both A-beta in the NPs and NFTs. The proteoglycans are a family of complex macromolecules consisting of a protein core to which glycosaminoglycan (GAG) chains are covalently attached. HSPG has been shown to bind to A-beta, accelerate its fibril formation, and maintain its fibril stability. In AD and other neurodegenerative disorders, tau becomes hyperphosphorylated hence it is unable to bind to microtubules which results in the production of paired helical filaments, a building unit of NFTs. It has been shown in vitro that sulfated GAGs induce the formation of paired helical-like filaments under physiological conditions from tau. Furthermore, an interaction between HSPG and apolipoprotein E (a potent risk factor of AD) has been shown to be involved in neurodegeneration. Thus, substantial evidence exists to underscore important roles of HSPG in the etiology of AD.

[Imaging of myocardial perfusion and metabolism with positron emission tomography]

Positron emission tomography (PET) has been providing new information in the diagnosis and the pathophysiological assessment of heart diseases. The PET tracers commonly used in Japan are 13N-ammonia, 18F-fluorodeoxyglucose (FDG) for imaging of myocardial perfusion and metabolism, respectively. Measurement of regional myocardial blood flow by 13N-ammonia dynamic PET scan and a compartment model analysis is applied to the functional estimation of coronary stenotic lesions and the detection of perfusion abnormalities in hypertrophic heart diseases, familial hyperchlesterolemia and other diseases with possible microvascular lesions. 18F-FDG is commonly used to differentiate ischemic but viable tissue from myocardial scar in coronary artery disease and also used to detect cardiac tumor and the cardiac involvement in sarcoidosis. In addition to these two tracers, 11C-acetate is now expected to provide the clinical analysis of pathophysiology of heart failure by estimating the efficiency of energy conversion of the heart into external work.

Acetazolamide induced myocardial ischemia in patients with severe coronary artery disease

Acetazolamide (ACZ)-augmented brain SPECT is commonly used for evaluating cerebral vascular reserve in patients with cerebrovascular disease. ACZ may cause myocardial ischemia in patients with coronary artery disease. To evaluate the risk of induction of myocardial ischemia with ACZ-augmented myocardial SPECT, we performed combined ACZ-augmented Tl-201 myocardial SPECT (ACZ-myo SPECT) with Tc-99m HMPAO brain SPECT in patients with severe coronary artery disease.

METHODS

Nine patients underwent combined ACZ-myo SPECT with Tc-99m HMPAO brain SPECT. (1) For qualitative analysis, SPECT images were divided into 13 segments to calculate the total defect scores. (2) Six ROIs were placed on the slices in the myocardial SPECT short-axis images and the regional uptake ratio was obtained as the ratio of the mean counts in the myocardium to the maximal count in the slice. The total defect score and regional uptake ratio of ACZ-myo SPECT were compared with those of early and delayed dipyridamole Tl-201 myocardial SPECT (DP-Tl SPECT) images.

RESULTS

(1) In the 21 coronary artery territories with coronary stenosis > or = 75%, the total defect score in ACZ-myo SPECT, early and delayed DP-Tl SPECT images were 3.52 +/- 4.14*, 4.19 +/- 4.65* and 2.25 +/- 3.34, respectively (*: p < 0.05 vs. delayed DP-Tl SPECT images). (2) In 44 of 54 ROIs with coronary stenosis > or = 75%, the regional uptake ratio of ACZ-myo SPECT, early and delayed DP-Tl SPECT images were 0.670 +/- 0.166**, 0.677 +/- 0.194**, 0.721 +/- 0.178, respectively (**: p < 0.01 vs. delayed DP-Tl SPECT images). Systolic blood pressure fell at 11 min after ACZ infusion without electrocardiographic ST-T changes or chest pain.

CONCLUSION

As ACZ has the potential to cause myocardial ischemia, ACZ-augmented brain SPECT should be performed with caution in patients with severe coronary artery disease associated with cerebrovascular disease.

Comparison of dual-isotope acquisition of 201Tl and 99Tcm-tetrofosmin for the detection of ischaemic heart disease and determination of the optimal imaging time of 99Tcm-tetrofosmin

Comparative studies of thallium-201 (201Tl) and 99Tcm-tetrofosmin for the detection of ischaemic heart disease (IHD) have previously been reported. These 201Tl and 99Tcm-tetrofosmin studies were usually performed separately with different exercise loads at an interval of several days. Here, we used a dual-isotope technique with exercise myocardial SPET (single photon emission tomography) in 17 patients with IHD and 10 patients with normal coronary arteries. The triple-energy window (TEW) method was applied for cross-talk correction. SPET imaging was performed at 10 and 70 min (S1 and S2) after the injection of 99Tcm-tetrofosmin (222 MBq) and 201Tl (74 MBq) at peak exercise to determine the optimal imaging time of 99Tcm-tetrofosmin. The S2 value was obtained 35 min after the subject drank a glass of milk to accelerate hepatobiliary clearance. Twenty-five minutes after S2, 37 MBq of 201Tl were reinjected at rest and SPET imaging (S3) was performed. Immediately after S3, 666 MBq of 99Tcm-tetrofosmin were reinjected and SPET imaging (S4) was performed 50 min later. Representative short and vertical long axis tomograms were divided into 17 segments. Each segment was assessed using a 4-point scoring system. The defect score was defined as the sum of each segmental score. The defect scores for imaging at exercise were 14.3 +/- 11.4 for 201Tl at S1, 11.4 +/- 8 for 99Tcm-tetrofosmin at S1 and 9.7 +/-9.8 for 99Tcm-tetrofosmin at S2 (P < 0.01), respectively. The washout rate of 99Tcm-tetrofosmin for the first hour was 15.5 +/- 7.3% and 11.8 +/- 7.7% (P < 0.01), respectively, for the normal and ischaemic segments. The image quality of 201Tl at S1 was almost equivalent to that of 99Tcm-tetrofosmin at S1/S2. The overall sensitivity and specificity for the detection of ischaemia was 94% and 82% for 201Tl at S1, 89% and 86% for 99Tcm-tetrofosmin at S1, and 88% and 95% for 99Tcm-tetrofosmin at S2, respectively. The overall accuracy was 86%, 88% and 92%, respectively. The myocardial viability score was 7.4 +/- 7.1 for 201Tl at S3 and 5.8 +/- 7.0 for 99Tcm-tetrofosmin at S4 (P < 0.01). The results indicate that the diagnostic accuracy of 99Tcm-tetrofosmin for myocardial ischaemia is almost equivalent to that of 201Tl as assessed by dual SPET imaging, and that the optimal imaging time for 99Tcm-tetrofosmin is within 10-35 min (S1) after exercise.

[Evaluation of the automatic quantification of left ventricular function using ECG gated 99mTc-MIBI myocardial SPECT]

We studied the accuracy of left ventricular (LV) volumes and ejection fraction (EF) derived from ECG gated 99mTc-sestamibi myocardial perfusion SPECT (G-SPECT) and the software for automatic data analysis (QGS program described by Germano G et al.). G-SPECT was performed in 29 patients with various cardiac diseases. LV end-diastolic and end-systolic volumes (LVEDV and LVESV), and LVEF determined by QGS program were compared to those by Simpson method in biplane left ventriculography (LVG). Interobserver reproducibility in measuring the G-SPECT parameters was excellent (LVEDV: r = 0.99, LVESV: r = 0.99, LVEF: r = 0.97). There was a good correlation between the values obtained from G-SPECT and LVG (LVEDV: r = 0.92, LVESV: r = 0.94, LVEF: r = 0.85), but G-SPECT tended to underestimate LVEDV and LVEF. In 17 patients with moderate to severe myocardial perfusion defects selected from the subjects, the correlation was maintained fairly high (LVEDV: r = 0.90, LVESV: r = 0.92, LVEF: r = 0.77). In conclusion, QGS program provides high accuracy and reproducibility in determining LV volumes and LVEF from G-SPECT.

[Analysis of genome-type, serovar and antibiotic susceptibility of Pseudomonas aeruginosa isolated in Beijing Hospital China in 1991 to 1993]

We analyzed the in vitro antibiotic susceptibility pattern and serovar for 192 strains of Pseudomonas aeruginosa isolated at Beijing Hospital(China) from October 1991 to October 1993. The frequency of resistant strains was high, more than 15%, for ceftazidime, cefsulodin, cefoperazone, aztreonam, gentamicin, tobramycin, tosufloxacin, ofloxacin and fosfomycin. The incidence of resistants against piperacillin and imipenem was significantly low. Among the 192 strains, 16 were designated as being multi-drug resistant strains(i.e.; resistant to more than 8 drugs out of 11 drugs), and all of the multi-drug resistant strains were isolated from inpatients. Predominant serovar of 192 strains were 60(31.3%) for G, 28(14.7%) for E, and 24(12.5%) for I. Multi-drug resistant strains have no characteristic serovar. Restriction enzyme SpeI digestion analysis(using pulse field electrophoresis) of P. aeruginosa-genome yielded several common patterns, and was shown to be useful for tracing the route of nosocomial infection. Further, isolates with closely related genome type, in which the size of one digested band was different, showed a different minimum inhibitory concentration of fosfomycin in one genome type or new quinolones in the other genome type. Analysis of genome type and antibiotic susceptibility pattern may exhibit the antibiotic resistant gene.

Evaluation of left ventricular ejection fraction from radial long-axis tomography: a new reconstruction algorithm for ECG-gated technetium-99m sestamibi SPECT

Radial long-axis tomography can provide views similar to contrast left ventriculography (LVG) including the basal and apical areas of the left ventricle, not possible in routine short-axis tomography. We applied this method to ECG-gated Tc-99m Sestamibi (MIBI) myocardial SPECT images to estimate the left ventricular ejection fraction (LVEF).

METHODS

ECG-gated Tc-99m MIBI SPECT was performed with a temporal resolution of 10 frames per R-R interval. LVEF was calculated on the basis of left ventricular volume estimates at end diastole (ED) and end systole (ES) with using an ellipsoid body model. To validate this method, LVEF's derived from ECG-gated Tc-99m MIBI SPECT were compared with those from LVG in 11 patients with coronary artery disease.

RESULTS

There was a close linear correlation between LVEF values calculated from Tc-99m MIBI SPECT and those from LVG (r = 0.89, p < 0.001), although the gated SPECT underestimated LVEF compared to LVG. The technique showed excellent reproducibility (intra-observer variability, r = 0.96, p < 0.001; inter-observer variability, r = 0.71, p < 0.005).

CONCLUSION

The radial long-axis tomography technique gives a good estimate of LVEF, in agreement with estimates based on LVG. ECG-gated Tc-99m MIBI SPECT can, therefore, be applicable to assess myocardial perfusion and ventricular function at the same time.

Contribution of hypoxia to the development of cardiomyopathy in hamsters

OBJECTIVE

It has been hypothesized that microvascular spasms cause cardiomyopathy. To elucidate the contribution of hypoxia to the development of cardiomyopathy, the newly-developed hypoxia tracer, Tc-99m nitroimidazole, was applied to detect myocardial hypoxia in a hamster model.

METHODS

Tc-99m nitroimidazole (180 MBq) and I-125 iodoantipyrine (370 kBq) were injected into cardiomyopathic Syrian hamsters or control hamsters at age 10, 25, and 40 weeks (n = 6 in each group). The myocardial uptake of Tc-99m nitroimidazole was measured and dual tracer autoradiography was performed.

RESULTS

Histologic study revealed that the cardiomyopathic hamsters at age 10, 25 and 40 weeks were in the myocytolytic stage, the fibrotic and healing stage, and the hypertrophy and dilatation stage, respectively. Tc-99m nitroimidazole uptake was significantly greater in the cardiomyopathic hamsters than in the controls at age 25 weeks (cardiomyopathic hamsters, 33.3 +/- 4.7% g dose/g; control, 25.2 +/- 3.1), whereas there were no significant differences between both strains at age 10 and 40 weeks. The quantified concentration of I-125 iodoantipyrine in the cardiomyopathic hamster at age 40 weeks was significantly lower than that in the controls. When the Tc-99m nitroimidazole uptake was normalized by I-125 iodoantipyrine concentrations, the cardiomyopathic hamsters at age 25 and 40 weeks showed significantly greater uptake than the controls.

CONCLUSION

The myocardium in cardiomyopathic hamsters was hypoxic at the fibrotic and healing stage and may be hypoxic at the hypertrophy and dilatation stage. This may contribute to the development of cardiomyopathy.

G1 accumulation caused by iron deprivation with deferoxamine does not accompany change of pRB status in ML-1 cells

We analyzed G1 accumulation induced by the iron chelator deferoxamine B mesylate (DFO) compared it with that caused by etoposide and cytosine arabinoside (AraC). The results showed that p53 protein increased with all three treatments without an increase in p53 mRNA. After treatment for 3 or 6 h, p21 mRNA increased with 10(-4) DFO to 159% or 556% of pretreatment levels, to 509% or 391% with 10(-5) etoposide, and to 263% or 304% with 10(-5) AraC. Induction of p21 protein was not observed with fluorescence activated cell sorting and Western blot analysis after treatment with DFO or AraC. Treatment with DFO did not cause any change in levels of CDK4 mRNA or protein, whereas etoposide or AraC treatment did diminish CDK4 protein. Enzyme linked immunosorbent assay for pRB and its phosphorylation, which reflects CDK4 activity, revealed that treatment with DFO did not change the amount of pRB or the phosphorylation status. Results of this investigation show that the mechanism of G1 accumulation induced by DFO involves a p53-independent pathway and that expression of p21 protein may be regulated posttranscriptionally.

Quantification of systolic count increase in technetium-99m-MIBI gated myocardial SPECT

This study was performed to clarify the validity of quantification of myocardial wall thickening by the count increase method using electrocardiography (ECG)-gated SPECT.

METHODS

We performed a phantom study to examine the quantification of this method and to clarify the relationship between the changes of relative counts and objective size (such as myocardial wall) under various conditions. In addition, in volunteers, the percent count increase (%CI) was analyzed in left ventricular segments based on circumferential profile curve analysis by ECG-gated SPECT with 99mTc-MIBI (methoxyisobutyl-isonitrile), and it was compared with the regional systolic wall thickness (%Th) assessed by echocardiography during low-dose dobutamine infusion.

RESULTS

In our phantom study, the relative count changes were correlated linearly with the object size only within less than 20 mm. Recovery coefficient curves were influenced by acquisition parameters such as type of collimator, diameter of camera rotation, counts and photon scattering. In ECG-gated SPECT, the %CI value was increased gradually at each stage after dobutamine infusion, in relation to the increase of the %Th seen on echocardiography, although there are significant large deviations between these two parameters.

CONCLUSIONS

In this study, quantitative analysis based on the %CI in ECG-gated SPECT may underestimate regional wall thickening. These data should be considered in the evaluation of the %CI as an index of myocardial function.

Effect of methionine depletion on growth and apoptosis in various tumor cell lines

Sodium ascorbate, sodium 5,6-benzylidene-L-ascorbate (SBA), gallic acid and caffeic acid induced apoptotic cell death in human myelogenous leukemic cell lines, and stimulated oxidation of methionine into methionine sulfoxide in the culture medium. When various tumor cell lines were cultured in methionine-free medium, their growth was nearly terminated at G1 phase of the cell cycle, producing much smaller number of apoptotic cells. Addition of methionine sulfoxide to the methionine-free medium did not stimulate the apoptosis induction. These data suggest that induction of apoptosis by ascorbates, gallate or by caffeate cannot be simply explained by methionine oxidation.