[Non-steroidal antiinflammatory drug--management of gastrointestinal complications and inhibition of COX-2]

Non-steroidal antiinflammatory drugs (NSAID) are widely used for the treatment of rheumatoid arthritis and other collagen vascular diseases, and now more than 30 drugs are available. However, caution should be paid in using NSAIDs because of their serious side effects, especially gastrointestinal toxicity. Misoprostol has been shown to prevent NSAID-induced gastrointestinal damage, and proton-pump inhibitor omeprazole and misoprostol have been shown to be effective in the treatment of ulcers and erosions induced by NSAIDs. After the discovery of cyclooxygenase-2 (COX-2), investigators have raised a hypothesis that specific inhibitor of COX-2 should have anti-inflammatory activity with least gastrointestinal toxicity. According to this, efforts have been paid to produce COX-2 selective inhibitors. Although several COX-2 inhibitors have been reported to show reduced toxicity, further investigations are needed to establish their usefulness.

CD28-Deficient Mice Are Highly Resistant to Collagen-Induced Arthritis

CD28 provides a critical costimulatory signal in Ag-specific T cell activation. Recent studies have revealed an important role for CD28 in the development of autoimmune diseases. We have examined the role of CD28 in collagen-induced arthritis (CIA) by inducing CIA in CD28-deficient DBA/1 mice. CD28-deficient mice never developed arthritis and showed markedly decreased levels of IgG and IgM anti-type II collagen (CII) Abs. In addition, the CD28+/− mice had similar levels of IgG1 and IgG2a anti-CII Abs, whereas in the CD28-deficient mice the level of IgG1 anti-CII Abs was decreased compared with that of IgG2a. IFN-γ production by lymph node cells in response to CII was also reduced. CD28-deficient mice were either immunized four times with CII in CFA to augment Ag loading or given low doses of IL-12 to enhance Th1 type responses. Both treatments resulted in a very low incidence of CIA development and minimal disease. CD28-deficient mice developed arthritis from injection of lymph node cells from CII-immunized wild-type mice, followed by immunization with CII in CFA. Taken together, these results indicate that costimulation of CD28 cannot be replaced by repeated activation through TCR or other costimulatory molecules. Thus, CD28 plays a critical role in both cellular and humoral immunity against CII and is indispensable for the development of CIA.

CD28-deficient mice are highly resistant to collagen-induced arthritis

CD28 provides a critical costimulatory signal in Ag-specific T cell activation. Recent studies have revealed an important role for CD28 in the development of autoimmune diseases. We have examined the role of CD28 in collagen-induced arthritis (CIA) by inducing CIA in CD28-deficient DBA/1 mice. CD28-deficient mice never developed arthritis and showed markedly decreased levels of IgG and IgM anti-type II collagen (CII) Abs. In addition, the CD28+/- mice had similar levels of IgG1 and IgG2a anti-CII Abs, whereas in the CD28-deficient mice the level of IgG1 anti-CII Abs was decreased compared with that of IgG2a. IFN-gamma production by lymph node cells in response to CII was also reduced. CD28-deficient mice were either immunized four times with CII in CFA to augment Ag loading or given low doses of IL-12 to enhance Thl type responses. Both treatments resulted in a very low incidence of CIA development and minimal disease. CD28-deficient mice developed arthritis from injection of lymph node cells from CII-immunized wild-type mice, followed by immunization with CII in CFA. Taken together, these results indicate that costimulation of CD28 cannot be replaced by repeated activation through TCR or other costimulatory molecules. Thus, CD28 plays a critical role in both cellular and humoral immunity against CII and is indispensable for the development of CIA.

[An analysis of fever of unknown origin defined by newly proposed practical criteria. A prospective study of 56 cases]

The criteria proposed by Petersdorf has been in use internationally to define the fever of unknown origin (FUO) since 1961 and the research of FUO has progressed with this criteria. Mean-while, new diagnostic methods have been developed and illness behavior of febrile patients has changed considerablly. Accordingly, the definition by Petersdorf is becoming less matched to current clinical situation. Therefore, we have developed a new practical criteria of FUO; i.e., out-patients who are febrile more than 2 weeks, documented temperature higher than 37.5 degrees C at least on one occasion and undetermined diagnosis and in-patients who are febrile more than 1 week with documented temperature higher than 37.5 degrees C, and undetermined diagnosis. Between October 1, 1993, and October 31, 1996, we prospectively collected a series of febrile patients who fulfilled our new criteria. We identified 56 patients by our criteria (23 male and 33 female, age: 49.7 +/- 20.6. range 15 to 88). Of this 56 patients, 19 (32%) were found to have infections, 18 (31%) had collagen disorders, 5 (9%) had malignancy and 6 (10%) had died. Of 56 patients, 38 (68%) were in the newly added group. Of these 38 patients, 4 patients had subacute necrotizing lymphoadenitis, 4 cytomegalovirus infection, 3 polymyalgia rheumatica, 3 tuberculosis. Four patients (10%) died. With our criteria, febrile patients who previously had not been included were found to have as poor a prognosis as with the Petersdorf group.

Helminth parasites of the rare endemic catfish, Liobagrus reini, in Japan

Examinations of 29 specimens of the catfish Liobagrus reini Hilgendorf (Siluriformes: Amblycipitidae), a species endemic to Japan, collected from the Sho River, Toyama Prefecture, in central Honshu, revealed the presence of four species of helminth parasites: Plagioporus honshuensis sp. n. (Trematoda), Rhabdochona coronacauda Belouss, 1965, R. japonica Moravec, 1975 and Mexiconema liobagri sp. n. (all Nematoda). The new opecoelid trematode P. honshuensis is characterized mainly by the extent of vitelline follicles, the size ratio of the suckers (1 : 1.7-2.1), the situation of testes near the middle of the body and by the structure, size and shape of the cirrus sac. Allopodocotyle Pritchard, 1966 is considered a junior synonym of Plagioporus Stafford, 1904. The males of R. japonica are described for the first time and conspecific females are redescribed; this species is a specific parasite of L. reini. The principle hosts of R. coronacauda are cyprinids and, therefore, its finding in the catfish may indicate an accidental infection; L. reini represents a new host record. M. liobagri (only females were found) from the host's abdominal cavity is the second known species of this dracunculoid genus, being characterized by the position of the excretory pore and the number (1) of caudal processes in the female. The recorded helminths are briefly described and illustrated and problems of their systematic status are discussed.

Improvement of systemic lupus erythematosus activity by the association of delayed onset Cushing's syndrome

We describe a 43-year-old woman with systemic lupus erythematosus (SLE) who had complete resolution of all SLE symptoms as a result of hypercortisolemia induced by a glucocorticoid-producing adenoma of the left adrenal gland. After an adrenalectomy, she developed an SLE exacerbation, characterized by photosensitivity, polyarthralgia, and hemolytic anemia, which required intensive steroid therapy. This is the first report of a patient with SLE entering apparent remission due to excessive adrenal secretion of glucocorticoids.

Trebius shiinoi n. sp. (Trebiidae: Siphonostomatoida: Copepoda) from uteri and embryos of the Japanese angelshark (Squatina japonica) and the clouded angelshark (Squatina nebulosa), and redescription of Trebius longicaudatus

Trebius shiinoi n. sp. is described from females and males collected from the uterine linings and on embryos within the uteri of 2 near-term Japanese angelsharks (Squatina japonica Bleeker, 1858) captured in Suruga Bay, off central Japan, and from female specimens reported by Shiino in 1963 that were found on embryos of the clouded angelshark (Squatina nebulosa Regan, 1906) captured off Shirahama, central Japan. Shiino identified his specimens as Trebius longicaudatus Shiino, 1954. However, our comparisons between Shiino's specimens and those newly collected revealed both to represent the same species, and comparisons of these specimens to 5 syntypes of T. longicaudatus and to published information detailing other Trebius species revealed them to be a new species that differs most notably from its congeners by the enormous length of its transformed adult female's abdomen and by the presence of a distinctive nublike seta on her caudal ramus. Trebius shiinoi n. sp. is an unusual copepod because it is an endoparasite of adult female angelsharks as well as an ectoparasite of embryo angelsharks, and it is proposed that flushing of the uterine-cloacal chambers of clouded angelsharks and Japanese angelsharks may facilitate T. shiinoi infections. A redescription of T. longicaudatus is also provided.

Ventriculoatrial block during atrioventricular nodal reentrant tachycardia utilizing multiple retrograde pathways

A rare case of narrow QRS tachycardia continuing despite the occurrence of VA block is reported. Right ventricular stimulation suggested dual AV nodal physiology. The tachycardia was induced by ventricular premature stimulation, which failed to depolarize the atrium. Two types of tachycardia that had different retrograde conduction sequences, HA intervals, and cycle lengths were induced. The occurrence of VA block did not terminate the tachycardia but transiently prolonged the tachycardia cycle length. These findings suggest the mechanism is AV nodal reentry utilizing multiple retrograde pathways with intranodal reentry bridging the VA block and maintaining the tachycardia.

Kinetics of buccal absorption of propafenone single oral loading dose in healthy humans

Buccal absorption has an advantage when compared with other administration routes because of its rapid onset of action. We examined the pharmacokinetics of buccal-absorbed propafenone in healthy humans. 1. After a single oral administration of 150 mg of propafenone, the average peak concentration of propafenone was 27.9+/-2.5 ng/ml, and that of 5-hydroxypropafenone was 61.7+/-6.6 ng/ml (n=5). The times to reach peak serum concentrations of propafenone and 5-hydroxypropafenone were 1.8+/-0.1 hr and 1.5+/-0.2 hr, respectively. 2. After a buccal absorption of 150 mg of propafenone, the time to reach peak serum concentration of propafenone was 16.9+/-2.3 min (n=8). The average peak concentration of propafenone was 30.4+/-1.4 ng/ml (n=8), and the concentrations of 5-hydroxypropafenone were below the detection limit in all subjects. The rapid upstroke of serum concentrations of propafenone by buccal administration may cause rapid onset of pharmacological conversion.

Genetic Basis of Human Complement C8α-γ Deficiency

Deficiency of the α-γ subunit of the eighth component of complement (C8α-γD) is frequently associated with recurrent neisserial infections, especially meningitis caused by Neisseria meningitidis. We here report the molecular basis of C8α-γD in two unrelated Japanese subjects. Screening all 11 exons of the C8α gene and all 7 exons of the C8γ gene and their boundaries by exon-specific PCR/single-strand conformation polymorphism demonstrated aberrant single-stranded DNA fragments in exon 2 of C8α gene in case 1 and in exons 2 and 9 of C8α gene in case 2. Nucleotide sequencing of the amplified DNA fragments in case 1 revealed a homozygous single-point mutation at the second exon-intron boundary, inactivating the universally conserved 5′ splice site consensus sequence of the second intron (IVS2+1G→T). Case 2 was a compound heterozygote for the splice junction mutation, IVS2+1G→T, and a nonsense mutation at Arg394 (R394X). R394X was caused by a C to T transition at nucleotide 1407, the first nucleotide of the codon CGA for Arg394, leading to a stop codon TGA. No mutations were detected in the C8γ gene by our method. Our results indicate that the pathogenesis of C8α-γD might be caused by heterogeneous molecular defects in the C8α gene.

Genetic basis of human complement C8 alpha-gamma deficiency

Deficiency of the alpha-gamma subunit of the eighth component of complement (C8alpha-gammaD) is frequently associated with recurrent neisserial infections, especially meningitis caused by Neisseria meningitidis. We here report the molecular basis of C8alpha-gammaD in two unrelated Japanese subjects. Screening all 11 exons of the C8alpha gene and all 7 exons of the C8gamma gene and their boundaries by exon-specific PCR/single-strand conformation polymorphism demonstrated aberrant single-stranded DNA fragments in exon 2 of C8alpha gene in case 1 and in exons 2 and 9 of C8alpha gene in case 2. Nucleotide sequencing of the amplified DNA fragments in case 1 revealed a homozygous single-point mutation at the second exon-intron boundary, inactivating the universally conserved 5' splice site consensus sequence of the second intron (IVS2+1G-->T). Case 2 was a compound heterozygote for the splice junction mutation, IVS2+1G-->T, and a nonsense mutation at Arg394 (R394X). R394X was caused by a C to T transition at nucleotide 1407, the first nucleotide of the codon CGA for Arg394, leading to a stop codon TGA. No mutations were detected in the C8gamma gene by our method. Our results indicate that the pathogenesis of C8alpha-gammaD might be caused by heterogeneous molecular defects in the C8alpha gene.

[A case of hypoxemic acute bronchiolitis presenting with diffuse nodular shadows caused by Mycoplasma pneumoniae]

A fifty year-old female who had previously been well presented with a productive cough and a high fever. Her initial chest X-ray film showed no abnormal lung shadows. Despite partial improvement of the fever and the serum level of acute phase reactant (CRP) in response to intravenous administration of piperacillin, she complained of increasing severity of cough and dyspnea. Follow-up chest X-ray films taken five days after therapy with piperacillin showed diffuse nodular shadows in the mid-to-lower lung fields bilaterally. Chest CT scan disclosed diffuse miliary nodules at the lung periphery and thickening of bronchovascular markings. Chest auscultation revealed late inspiratory coarse crackles and expiratory wheezing, and the patient's arterial oxygen tension was 61 mmHg. Suspected of suffering from primary atypical pneumonia, she was started on therapy with intravenous minocyclin (200 mg/day), two days after treatment her symptoms began improving significantly. Anti-mycoplasma antibody was found to be x 1280, and cold hemoagglutinin x 1024, establishing the diagnosis of Mycoplasma pneumoniae infection. The patient's condition completely recovered following a one week treatment with minocyclin. We concluded that her respiratory infection was caused by piperacillin-sensitive mico-organism, and also Mycoplasma pneumoniae which brought about hypoxic acute bronchiolitis to the patient.

Analysis of CD40 ligand gene mutations in patients with primary biliary cirrhosis

An elevated immunoglobulin (Ig)M concentration in serum is a common and distinctive feature of primary biliary cirrhosis (PBC). Little is known, however, about the mechanism of hyper-IgM in PBC. CD40 ligand (CD40L) has a crucial role in immunoglobulin class switching in B cells. Mutations in the gene encoding CD40L are known to induce X-linked hyper-IgM syndrome. To identify mutations in the gene for CD40L in PBC patients, we analyzed CD40L gene mutations, using reverse transcription (RT)-PCR single-strand conformation polymorphism (SSCP) analysis. No mutations were detected in cDNA from any of 24 PBC patients by the RT-PCR-SSCP technique. These data suggest that other, unidentified mechanisms are involved in hyper-IgM in PBC patients.

Two new Huffmanela species, H. japonica n. sp. and H. shikokuensis n. sp. (Nematoda: Trichosomoididae), from marine fishes in Japan

Two new species of trichuroid nematodes. Huffmanela japonica n. sp. and Huffmanela shikokuensis n. sp., are established on the basis of their egg morphology and biological characters; the eggs of both species occur in the musculature of marine fishes from the Inland Sea of Japan. The dark-shelled eggs of H. japonica are found locally in masses ("black spots") in the flesh of Upeneus bensasi (Temminck et Schlegel) (Mullidae, Perciformes) and are characterized mainly by their shape and size (58-69 x 26-30 microm), an aspinose superficial transparent envelope enclosing the egg proper, relatively small polar plugs, and by their thick egg wall (4-5 microm). The eggs of H. shikokuensis are also dark-colored and are found evenly distributed in the musculature of Stephanolepis cirrhifer (Temminck et Schlegel) (Monacanthidae, Tetraodontiformes); they are characterized mainly by their shape and size (78-90 X 36-45 microm), by a very thin and aspinose superficial transparent envelope, large polar plugs, and relatively thin egg wall (3 microm). Histological sections of the host's infected musculature showed the presence of H. shikokuensis nematodes inside the muscle cells and in the intercellular spaces. A key to Huffmanela species based on egg morphology is provided.

Possibility of contribution of nucleoside transport systems to pirarubicin uptake by HL60 cells but not mononuclear cells

Previously, we reported that pirarubicin (THP), an anthracycline, was taken up, at least in part, by both human leukemic HL60 cells and mononuclear cells (MNCs) via a carrier-mediated system. In this study, the possibility of a contribution of nucleoside transport systems to the uptake of THP by HL60 cells and MNCs was investigated. The experiments were performed after both types of cells had been pretreated with a metabolic inhibitor, 2,4-dinitrophenol, to deplete cellular ATP. In HL60 cells, THP uptake was increased and decreased significantly by treatment with equilibrative nucleoside transport inhibitors, nitrobenzylthioinosine (NBMPR), nitrobenzylthioguanosine and dilazep, in the presence and absence, respectively, of an inwardly directed Na+-gradient. THP uptake by HL60 cells showed an overshoot in the presence of the gradient, and was decreased by treatment of the cells with monensin, indicating that the uptake partially depended on the Na+-gradient. In HL60 cells in which equilibrative nucleoside transport was inhibited by NBMPR, THP uptake in the presence of the gradient was inhibited by Na+-dependent concentrative nucleoside transport inhibitors, but no inhibition was observed in the absence of the gradient. In MNCs, conversely, there was no effect of any equilibrative nucleoside transport inhibitor or the Na+-gradient on THP uptake. These results suggested that THP was taken up, at least in part, via both equilibrative and concentrative nucleoside transport systems in HL60 cells, but not in MNCs.

Comparative study on the clinical efficacy of theophylline variable serum concentrations therapy and round-the-clock therapy

Depending on the administration method, highly effective therapeutic variable serum concentrations (VSC) of theophylline can be attained only in the time range of frequent asthma attacks. We used an oral sustained-release theophylline preparation in seven patients with bronchial asthma (two males and five females; mean age: 38.7 years) who had required more than two admissions per year due to bronchial asthma attacks, despite being treated with round-the-clock (RTC) therapy of theophylline and inhalation of steroids. We examined the annual frequency of admissions and the peak expiratory flow rate (PEFR) in remission. Even though no difference was noted in the serum concentrations of theophylline in the morning (the time range of attack) between RTC therapy and VSC therapy, the mean number of admissions during VSC therapy was 1.14, compared with 3.86 recorded during RTC therapy (p < 0.001). PEFR in remission showed a significant improvement with VSC therapy, compared with PEFR recorded during RTC therapy (p < 0.05). VSC therapy proved to be useful for patients who failed to attain favorable control of asthma attacks by RTC therapy.

Cross-correlation between 1/f-like fluctuations in heartbeat and diurnal changes in the sleep-waking stage

The cross-correlation function between diurnal changes in 1/f-like fluctuations of the R-R interval and those of the sleep-waking stage was calculated based on the data from six normal subjects in order to investigate the interactions among circadian components. Sleep stage was scored according to the standard criteria and waking stage was scored with criteria developed for the present study. Polysomnography was performed for 11 h during the daytime. The equation for 1/f was approximated using the power spectra of the R-R interval every 10 min. Cross-correlation analysis between sleep-waking stage and 1/f fluctuation of the R-R interval suggested that the neural network for 1/f fluctuation in heartbeat is influenced by the sleep-wake cycle with a time lag in the order of tens of minutes.

Role of Leptodora kindti (Cladocera: Leptodoridae) in the life cycle of Raphidascaris biwakoensis (Nematoda: Anisakidae), a fish parasite in Lake Biwa, Japan

Advanced third-stage larvae (body length 2.92 to 5.49 mm) of the fish nematode Raphidascaris biwakoensis Fujita, 1928 were found as frequent parasites of the leptodorid cladoceran Leptodora kindti (Focke) in Lake Biwa, southern Honshu, Japan, in July 1995. This is the first confirmed record of the L3 of this nematode species from an invertebrate host, showing that L. kindti may serve as a true intermediate host to R. biwakoensis, probably in addition to lower aquatic vertebrates. The high degree of prevalence of the nematode larvae in L. kindti in Lake Biwa indicates that this plankton crustacean is an important source of infection with R. biwakoensis for fish definitive and paratenic hosts.

A furanoid labdane diterpene from Potamogeton nodosus

A new furanoid diterpene, 15,16-epoxy-12-oxo-8(17), 13(16), 14-labdatrien-20,19-olide (1) was isolated from an ethanolic extract of Potamogeton nodosus. Its structure was elucidated by the usual spectroscopic methods, including 2D NMR techniques. Compound 1 was found to exhibit moderate inhibitory activity against a number of both Gram-positive and Gram-negative bacteria.

[Relationship between the experience of steroids side effects and noncompliance with oral steroids treatment in collagen disease patients]

PURPOSE

To analyze the relationship between the experience of side effect and the compliance with oral steroids drug treatment of the patients in Collagen Disease Clinic.

METHODS

A questionnaire survey through interview was conducted on 165 outpatients with various collagen disease at Saga Medical School Hospital.

RESULTS

94 patients (57%) had a history of noncompliance to the steroids drug. 49 patients (52.1%) adventitiously had forgotten to take the steroids as ordered and 45 patients (47.9%) intentionally had regulated their steroids dose or had discontinued the steroids drug treatment. Over 80% of the patients had experienced side effects of the steroids. The patients who experienced one or more of the following side effects, osteoporosis, bone fractures, menstrual disorders, moon face, central obesity, alopecia, acnelike eruption, manic-depressive state, and insomnia, intentionally regulated, or discontinued the steroids therapy. In addition, the patients who were not made cognizance about side effects of the steroids by their physicians and nurse tended to noncompliance group.

CONCLUSION

To increase the compliance rate with oral steroids drug treatment, we must make conscious efforts to inform the patients on the condition of their medical states, the efficacy of the prescribed drugs, and the side effects and risk concerning discontinuation of the steroids. It is Also necessary to establish "Drug information and counseling day" in outpatient Department.

[Coumarin-containing chiral discriminating agents. VII. New crystalline 1H-NMR enantiomeric excess determination reagent for alcohols and amines, (R)-(-)- and (S)-(+)-O-coumarinylmandelic acids]

The Mitsunobu reaction of commercial 4-hydroxycoumarin with both (R)-(-)- and (S)-(+)-tert-butyl mandelates derived from commercial enantiopure mandelic acids furnished (S)-(+)- and (R)-(-)-tert-butyl O-coumarinylmandelates which were, then, treated with trifluoroacetic acid to give novel crystalline optically pure (S)-(+)- and (R)-(-)-O-coumarinylmandelic acids [SCMOH and RCMOH], respectively in good overall yields. Diastereotopic nonequivalence 1H-NMR examination of the resultant esters and amides without any racemization or kinetic resolution by way of a Steglich's procedure (a DCC-DMAP method) has proved each acid to be a useful, efficient and reliable chiral derivatizing agent for the enantiomeric excess determination of chiral alcohols and amines.

[A case of Wegener's granulomatosis associated with refractory bowel granulomatous ulcers]

We describe a 58-year-old woman who developed Wegener's granulomatosis (WG) complicated by a perforation of the transverse colon caused by necrotizing granulomatous vasculitis. In addition, her colon lesion continued in spite of high dose corticosteroid and cyclophosphamide therapy. She was admitted to our hospital because of her severe tonsillitis in Dec., 1994. She was diagnosed as having WG because she had oral ulcer, antibiotics-resistant lung infiltration, renal dysfunction and positive C-ANCA. Just after we started high dose steroid therapy, the transverse colon was perforated because of vasculitis, and she underwent emergency operation. Many vasculitic lesions were found in the small intestine, colon, and mesenterium. The disease was improved by corticosteroid and cyclophosphamide therapy except for a sustained ulcer with necrotizing vasculitis in the sigmoid colon region even 1 year after the operation. Although WG rarely complicates digestive tract lesions as initial manifestations, they reach 12% of the causes of death of WG in Japan. Therefore, we should take care of digestive tract lesions when we follow-up patients with WG.

Transport mechanisms of idarubicin, an anthracycline derivative, in human leukemia HL60 cells and mononuclear cells, and comparison with those of its analogs

Transport mechanisms of idarubicin (IDA) in HL60 cells, as leukemia cells, and human mononuclear cells (MNCs), as normal cells, were investigated, and compared with those of its analogs. The uptake of IDA by both cell types was temperature- and concentration-dependent, was inhibited competitively by daunorubicin (DNR) and noncompetitively by adriamycin (ADR), and was stimulated by preloading of the cells with DNR and ADR, indicating the partial involvement of a carrier-mediated mechanism. On pretreatment of the cells with 2,4-dinitrophenol, IDA uptake by HL60 cells increased, but that by MNCs decreased, suggesting that IDA was partially taken up into HL60 cells via an energy-independent carrier system, and into MNCs via an energy-dependent one. We speculated that in HL60 cells the carrier concerned with IDA uptake was common to DNR and ADR, and that the binding site of IDA on the carrier was the same as that for DNR, but not that for ADR, while in MNCs the carrier system consisted of, at least in part, a carrier for DNR uptake and one for ADR uptake, and the binding site of IDA was identical to that for DNR in the former, but different from that for ADR in the latter. It appeared that the uptake of IDA was greater than those of pirarubicin, DNR and ADR in both HL60 cells and MNCs, and that IDA was incorporated into MNCs more efficiently than into HL60 cells because of the higher uptake efficacy of the carrier(s).

Remitting seronegative symmetrical synovitis with pitting edema associated with gastric carcinoma

We report a case of remitting seronegative symmetrical synovitis with pitting edema (RS3PE syndrome) associated with gastric carcinoma in an 80-year-old woman who developed polyarthritis with marked pitting edema of the dorsa of both hands and feet 7 days after fiberscopic examination of the stomach. A mass lesion was identified and histology of the biopsy specimen revealed gastric carcinoma. Polyarthritis and edema were partially relieved by an intraarticular injection of corticosteroid. Shortly after resection of the gastric carcinoma, her symptoms and signs disappeared. She has been free of symptoms for 3 yrs without medication.

Activation of inwardly rectifying potassium channels by muscarinic receptor-linked G protein in isolated human ventricular myocytes

Muscarinic receptor-linked G protein, Gi, can directly activate the specific K+ channel (IK(ACh)) in the atrium and in pacemaker tissues in the heart. Coupling of Gi to the K+ channel in the ventricle has not been well defined. G protein regulation of K+ channels in isolated human ventricular myocytes was examined using the patch-clamp technique. Bath application of 1 microM acetylcholine (ACh) reversibly shortened the action potential duration to 74.4 +/- 12.1% of control (at 90% repolarization, mean +/- SD, n = 8) and increased the whole-cell membrane current conductance without prior beta-adrenergic stimulation in human ventricular myocytes. The ACh effect was reversed by atropine (1 microM). In excised inside-out patch configurations, application of GTPgammaS (100 microM) to the bath solution (internal surface) caused activation of IK(ACh) and/or the background inwardly-rectifying K+ channel (IK1) in ventricular cell membranes. IK(ACh) exhibited rapid gating behavior with a slope conductance of 44 +/- 2 pS (n = 25) and a mean open lifetime of 1.8 +/- 0.3 msec (n = 21). Single channel activity of GTPgammaS-activated IK1 demonstrated long-lasting bursts with a slope conductance of 30 +/- 2 pS (n = 16) and a mean open lifetime of 36.4 +/- 4.1 msec (n = 12). Unlike IK(ACh), G protein-activated IK1 did not require GTP to maintain channel activity, suggesting that these two channels may be controlled by G proteins with different underlying mechanisms. The concentration of GTP at half-maximal channel activation was 0.22 microM in IK(ACh) and 1.2 microM in IK1. Myocytes pretreated with pertussis toxin (PTX) prevented GTP from activating these channels, indicating that muscarinic receptor-linked PTX-sensitive G protein, Gi, is essential for activation of both channels. G protein-activated channel characteristics from patients with terminal heart failure did not differ from those without heart failure or guinea pig. These results suggest that ACh can shorten the action potential by activating IK(ACh) and IK1 via muscarinic receptor-linked Gi proteins in human ventricular myocytes.

The significance of tumor necrosis factor (TNF) levels for rejection of joint allograft

This paper describes the efficacy of utilizing Tumor Necrosis Factor-alpha (TNF) as a detectable parameter of acute rejection after bone allografts. The authors used a bone-joint allograft model, transferring vascularized allograft knee joints across a major histocompatibility barrier, using three groups of rats divided into controls, non-immunosuppressed, and immunosuppressed with cyclosporine. The paper supplies preliminary information suggesting that TNF may be a marker for early bone-joint allograft rejection.

C5a induces tissue factor activity on endothelial cells

Tissue factor (TF) is an integral membrane glycoprotein that serves as a cofactor for blood coagulation factor VIIa. The induction of TF on the surface of endothelial cells is initiated by various stimuli including lipopolysaccharide, interleukin-1 beta, and tumor necrosis factor alpha. We have demonstrated that recombinant human C5a induces TF activity in a dose-dependent fashion in human umbilical vein endothelial cells (HUVEC). Peak activity (4.9-fold increase) was obtained 3-6 h after treatment with 10 microM C5a. TF mRNA as assessed by RT-PCR method was also significantly increased (3.75-fold) after 3 h incubation with C5a, suggesting that C5a induces TF activity on HUVEC, at least in part, by enhancing the level of TF mRNA. The increase in TF activity by C5a was inhibited by methylprednisolone. The induction of TF on endothelial cells by C5a may represent one of many potential interrelationships between the inflammatory and coagulation schemes.

Membrane tumor necrosis factor-alpha (TNF-alpha) expressed on HTLV-I-infected T cells mediates a costimulatory signal for B cell activation--characterization of membrane TNF-alpha

The 26-kDa membrane tumor necrosis factor-alpha (TNF-alpha) expressed on activated CD4(+) T cells is a novel candidate for the functional membrane molecule in T-B cell interactions. We found that normal human T cells, when infected with human T cell lymphotropic virus type I (HTLV-I) in vitro, were induced to express the 26-kDa membrane TNF-alpha. The infected T cells, through this molecule, activated autologous B cells to produce immunoglobulin (Ig)M in a contact-dependent manner, which was partially inhibited by anti-TNF-alpha antibody (Ab). IgG synthesis was not stimulated, however, probably because of lack of CD40 ligand expression on the infected T cells. Anti-TNF-alpha Ab treatment stimulated the secretion of interleukin (IL)-2 and interferon gamma (IFN-gamma) in the infected T cells. These effects were not induced by anti-TNF receptor Ab treatment. Anti-TNF-alpha Ab also induced the elevation of intracellular calcium concentration in the infected T cells. These results suggest that T cells expressing membrane TNF-alpha can be directly stimulated through this molecule. Thus, it is suggested that the 26-kDa membrane TNF-alpha on HTLV-I-infected T cells plays a role in polyclonal B cell activation and may be involved in the pathogenesis of some HTLV-I-associated diseases. Additionally, our results suggest a novel mechanism by which cytokine production can be modulated in these T cells through membrane TNF-alpha on their surface.

Production of the third and fourth component of complement (C3, C4) by smooth muscle cells

Production of the third and fourth components of complement (C3, C4) by smooth muscle cells was investigated by using normal human aortic smooth muscle cells (AoSMC), human smooth muscle cell line (G402) and vascular smooth muscle cells obtained from human umbilical cord vein (UVSMC). AoSMC spontaneously produced both C3 and C4 at 15 ng/10(6) cells/72 hr and 22 ng/10(6) cells/72 hr, respectively, and both were enhanced by interferon-gamma (IFN-gamma). Although phorbol 12-myristate 13-acetate (PMA) and tumour necrosis factor-alpha (TNF-alpha) enhanced C3 production, C4 production was reduced by these agents. On the other hand, G402 produced C4 but not C3 in a dose-dependent manner when cultured with IFN-gamma. UVSMC produced only a small amount of C3 and C4 compared with AoSMC or G402. C3 and C4 produced by AoSMC were confirmed to be identical with their human serum counterparts as determined by sodium dodecyl sulphate-polyacrylamide gel electrophoresis and measurement of haemolytic activity. Northern blotting analysis showed that the expression of mRNA of C3 and C4 was enhanced by TNF-alpha and IFN-gamma, respectively, in AoSMC. Our findings suggest the importance of smooth muscle cells as a source of components of complement in vascular diseases including vasculitis.

Transport mechanism of pirarubicin in human mononuclear cells

We studied the transport mechanism of pirarubicin (THP) in mononuclear cells (MNCs) obtained from healthy human donors. The THP uptake was time-, temperature-, concentration- and energy (in part)-dependent. The uptake of daunorubicin (DNR) and doxorubicin (ADR) was also concentration-dependent, and the transport of ADR consisted of saturable and nonsaturable components. In cis-inhibition experiments, ADR inhibited both THP and DNR uptake noncompetitively, while DNR showed competitive inhibition of the uptake of THP. The THP uptake rate appeared to be increased by preloading DNR, indicating a trans-stimulatory effect, but not with ADR. These results suggest that THP and DNR were taken up into MNCs via a common carrier-mediated transport system, but that the carrier of ADR might differ from that of THP and DNR. Furthermore, apparent differences in the affinity for the carrier, transport efficacy and substrate specificity of the transporter between MNCs and the human leukemia cell lines (HL60 and K562) were indicated.

Transport mechanisms of anthracycline derivatives in human leukemia cell lines: uptake of pirarubicin, daunorubicin and doxorubicin by K562 and multidrug-resistant K562/ADM cells

We studied the uptake mechanisms of anthracycline derivatives, pirarubicin (THP), daunorubicin (DNR) and doxorubicin (ADR), in K562 and multidrug-resistant K562/ADM cells, which overexpress a multidrug efflux pump P-glycoprotein (P-gp). The uptake of THP, DNR and ADR by K562 or K562/ADM cells was time-, temperature- and concentration-dependent. The THP and ADR uptake by the parental cells was not affected by treatment with 4 mM 2,4-dinitrophenol (DNP) alone or DNP plus a P-gp specific inhibitor, cyclosporin A (CyA, 10 microM), while the DNR uptake in the DNP treatment group was significantly greater than that in the control group. There was no difference in the uptake of THP between DNP-pretreated K562 cells and DNP plus CyA-pretreated K562/ADM cells. The uptake of DNR or ADR was almost equal in both types of cell treated with DNP alone. Every kinetic constant for THP, DNR and ADR uptake by the sensitive cells was approximately equal to that in the resistant cells, respectively, under the above conditions. THP uptake was noncompetitively inhibited and stimulated on simultaneous treatment and preloading, respectively, of DNR or ADR in each type of cell. ADR showed noncompetitive inhibition of DNR uptake by either type of cell. Therefore, it was suggested that a common carrier-mediated transport system was involved in the uptake of THP, DNR and ADR, and that their binding sites in the carrier might be different from one another in both K562 and K562/ADM cells.

[A case of POEMS syndrome with various complications]

A 65-year old man presented with complaints of sclerosis of skin and numbness in the extremities. During last 10 year, he had developed monoclonal gammopathy, Raynaud's phenomenon, ischemic heart disease, sigmoid colon cancer, hyperkalemia, polyneuropathy and scleroderma-like skin changes. Laboratory examinations revealed a monoclonal protein (IgA-lambda) and an elevated serum level of IL-6. Subsequently a diagnosis of POEMS syndrome was made based on the clinical features and laboratory findings which were characteristic of this syndrome. Further examinations showed the presence of glomerulonephritis and brain tumor. These various complications are of great interest in understanding the pathogenesis of POEMS syndrome.

[The effect of beraprost sodium on the Raynaud's phenomenon]

We investigated the effect of beraprost sodium (BPS) on the Raynaud's phenomenon on 15 patients with systemic sclerosis, 3 with mixed connective tissue disease and 1 with Raynaud's disease, respectively. After 12 weeks of administration of 60 micrograms/d BPS, the duration and the incidence of the Raynaud's symptom were significantly reduced and the dermal temperature on the fingers was found to be elevated. Of the parameters which are known to reflect vascular endothelial damages such as tissue plasminogen activator (t-PA), von Willebrand's factor (vWF) and endothelin, the plasma level of t-PA was significantly reduced by BPS. Furthermore, the capillary loop in the nail bed of the fingers seemed to increase in one patient by the treatment with BPS. These results suggest that BPS has a capacity to repair peripheral vascular damages resulting in the improvement of Raynaud's phenomenon.

Significance of the therapeutic range of serum theophylline concentration in the treatment of an attack of bronchial asthma

The purpose of this study was to evaluate the accuracy of the recommended theophylline therapeutic range in the treatment of acute airway obstruction. Twenty seven patients (20 to 64 years) with acute asthma attack were given aminophylline intravenously to obtain a theophylline concentration between 10 and 20 micrograms/ml. Peak expiratory flow rates (PEFR) and serum theophylline concentrations were measured before and after aminophylline injection. When a marked improvement was not seen after aminophylline injection, the treatment was followed by inhalation of a beta-agonist and intravenously administered hydrocortisone. In order to clarify the relationship between theophylline efficacy at a therapeutic level and PEFR, as measured before aminophylline administration, the patients were classified into four groups. Group A (n = 7): asthma attack persisted regardless of treatment with aminophylline, beta-agonist and hydrocortisone, group B (n = 7): asthma attack improved by aminophylline, beta-agonist and hydrocortisone, group C (n = 6): asthma attack improved by both aminophylline and beta-agonist, group D (n = 7): asthma attack improved by intravenous aminophylline alone. The means (+/- S.E.) PEFR before aminophylline administration were 94.3 +/- 11.31/min in group A, 114.3 +/- 10.01/min in group B, 196.7 +/- 22.21/min in group C, and 220.0 +/- 12.51/min in group D, respectively. There were significant differences in PEFR between the A and C, A and D, B and C, and B and D groups. These findings suggest that theophylline efficacy is not expected in patients with low PEFR (less than 2001/min) at the time of treatment of an attack, even if a therapeutic theophylline concentration was obtained.

[A case of SLE with the onset of pleuritis showing eosinophilia and elevation of serum IgE]

A 19 year old female was admitted to our hospital with complaints of fever, dyspnea and chest pain. Chest x-ray film showed a massive right pleural effusion. She was diagnosed to have systemic lupus erythematosus (SLE) because of malar rash, serositis (pleuritis), positive antinuclear antibody and positive anti-DNA antibody. Then she was successfully treated with 50 mg/d prednisolone. This case was unusual and of interest in that she had eosinophilia in the peripheral blood and exudative pleural effusion and a marked elevation of serum IgE level despite no history of allergic diseases and no evidence of parasite infections.

Molecular bases for inherited human complement component C6 deficiency in two unrelated individuals

Deficiency of the sixth component of complement (C6D) is frequently associated with recurrent neisserial infections, especially meningitis caused by Neisseria meningitidis. We here report the molecular bases of C6D in two unrelated subjects, one African American (case 1) and the other Japanese (case 2). Screening all 17 exons of the C6 gene and their boundaries by exon-specific PCR/single strand conformation polymorphism demonstrated aberrant single stranded DNA fragments in exon 12 of case 1 and exon 2 of case 2. Nucleotide sequencing of the amplified DNA fragments revealed a homozygous single-base deletion (G1936) in exon 12 case 1 and a heterozygous single base deletion (C291/C292/C293/C294) in exon 2 of case 2. Both mutations resulted in frame shifts and premature termination of the C6 polypeptide. Sequence-specific oligonucleotide probe hybridization and direct sequencing of exon 12 amplified from genomic DNA further supported the homozygosity of the mutation in case 1. Case 2 is apparently compound heterozygote, but the putative mutation in the other allele of the C6 gene remains unknown. Both case 1 and case 2 were homozygous for the C6A allotype. These data indicate that at least three distinct mutational events can cause C6D, single nucleotide deletions in exons 2 and 12, and a mutation yet unidentified. Thus, similar to other complement protein deficiencies, the pathogenesis of C6D appears to be heterogeneous.

Molecular bases for inherited human complement component C6 deficiency in two unrelated individuals

Deficiency of the sixth component of complement (C6D) is frequently associated with recurrent neisserial infections, especially meningitis caused by Neisseria meningitidis. We here report the molecular bases of C6D in two unrelated subjects, one African American (case 1) and the other Japanese (case 2). Screening all 17 exons of the C6 gene and their boundaries by exon-specific PCR/single strand conformation polymorphism demonstrated aberrant single stranded DNA fragments in exon 12 of case 1 and exon 2 of case 2. Nucleotide sequencing of the amplified DNA fragments revealed a homozygous single-base deletion (G1936) in exon 12 case 1 and a heterozygous single base deletion (C291/C292/C293/C294) in exon 2 of case 2. Both mutations resulted in frame shifts and premature termination of the C6 polypeptide. Sequence-specific oligonucleotide probe hybridization and direct sequencing of exon 12 amplified from genomic DNA further supported the homozygosity of the mutation in case 1. Case 2 is apparently compound heterozygote, but the putative mutation in the other allele of the C6 gene remains unknown. Both case 1 and case 2 were homozygous for the C6A allotype. These data indicate that at least three distinct mutational events can cause C6D, single nucleotide deletions in exons 2 and 12, and a mutation yet unidentified. Thus, similar to other complement protein deficiencies, the pathogenesis of C6D appears to be heterogeneous.

[A case of Takayasu arteritis diagnosed by magnetic resonance imaging]

We report a case of Takayasu arteritis. A woman, 24 years old, was admitted because of fever of unknown etiology. Infection was ruled out. Bruit and asymmetrical pulsation were not found. Ga-scintigram showed abnormal uptake in her upper abdomen. Abdominal echogram revealed neither evidence of abscess nor lymphadenopathy. On abdominal computed tomography, a wall thickening of the abdominal aorta was revealed. In addition, abdominal magnetic resonance imaging(MRI) showed a wall thickening and an enhanced image by gadrinium enhancement. Although we could not carry out conventional aortography because of an allergy to lidocaine, she was diagnosed as having Takayasu arteritis. In response to steroid therapy, the fever promptly dropped and the data indicating inflammation were improved. On the MRI examination after 40 days of steroid therapy, the wall thickening of the abdominal aorta was found to be less prominent. We conclude magnetic resonance imaging is useful for diagnosis and follow-up of early and acute stage of Takayasu arteritis.

Transport mechanism of anthracycline derivatives in human leukemia cell lines: uptake and efflux of pirarubicin in HL60 and pirarubicin-resistant HL60 cells

We studied the transport mechanism of pirarubicin (THP) in HL60 and its THP-resistant (HL60/THP) cells, which showed no expression of mdr1 mRNA on Northern blot analysis. Under physiological conditions, the uptake of THP by both types of cell was time- and temperature-dependent. The amount of drug transport in the resistant cells was significantly less than that in the parent cells within 3 min of incubation. THP uptake was significantly higher in the presence than in the absence of 4 mM 2,4-dinitrophenol (DNP) in glucose-free Hanks' balanced salt solution in both HL60 and HL60/THP cells and the increases were approximately equal. In the presence of DNP, the uptake of THP by both types of cell was concentration-dependent, and there were no significant differences in the apparent kinetic constants (Michaelis constant (Km), maximum velocity (Vmax) and Vmax/Km) for THP uptake between HL60 and HL60/THP cells. Additionally, THP transport was competitively inhibited by its analogue doxorubicin. The efflux of THP from HL60/THP cells was significantly greater than that from HL60 cells, and the release from both types of cell was completely inhibited by decreasing the incubation temperature to 0 degrees C and by treatment with DNP in glucose-free medium. In contrast, the P-glycoprotein inhibitors verapamil and cyclosporin A did not inhibit THP efflux. However, genistein, which is a specific inhibitor of multidrug resistance-associated protein (MRP), increased the THP remaining in the resistant cells, and the value was approximately equal to that of the control group in the sensitive cells. These results suggest that THP is taken up into HL60 and HL60/THP cells via a common carrier by facilitated diffusion, and then pumped out in an energy-dependent manner. Furthermore, the accelerated efflux of THP by a specific mechanism, probably involving MRP, other than the expression of P-glycoprotein, resulted in decreased drug accumulation in the resistant cells, and was responsible, at least in part, for the development of resistance in HL60/THP cells.

Transport mechanism of anthracycline derivatives in human leukemia cell lines: uptake and efflux of daunorubicin and doxorubicin in HL60 and its resistant cells and comparison with those of pirarubicin

We examined the transport mechanisms of daunorubicin (DNR) and doxorubicin (ADR) in HL60 and HL60/THP cells which were the non-P-glycoprotein-mediated resistant clone of the parent HL60 cells and showed a low degree of resistance, and compared them with those of pirarubicin (THP). In both lines, it appeared that the uptakes of DNR and ADR were time-, temperature- and concentration-dependent and energy independent, and the transport of DNR consisted of saturable and nonsaturable components. They were pumped out from the cells time-, temperature- and energy-dependently. There were no differences in the accumulation amount of either DNR or ADR between HL60 and HL60/THP cells. Comparing the transport of DNR or ADR with that of THP, the uptake amounts of DNR and THP were approximately equal, and were greater than that of ADR in both types of cell. In cis-inhibition experiments, DNR inhibited the THP uptake noncompetitively in the parent and resistant cells, in contradiction of the previously reported result in which ADR showed competitive inhibition (Nagasawa, K. et al., Cancer Chemother. Pharmacol., in press). The THP accumulation appeared to be increased by preload of DNR and ADR, indicating a counter transport. Thus, DNR and ADR as well as THP might be incorporated via a common carrier-mediated transport system, but DNR uptake in part appeared to follow a nonsaturable transport, and its binding site in the carrier might differ from that of THP and ADR in both HL60 and HL60/THP cells.

Urinary C4 excretion in systemic lupus erythematosus

The fourth component of complement (C4) in urine was measured in 19 patients with systemic lupus erythematosus (SLE). Urinary C4 was detectable in all SLE patients using an enzyme linked immunosorbent assay. In 11 of 13 patients whose urinary C4 was serially measured, a decrease of urinary C4 was found in parallel with a decrease of disease activity of SLE. In the remaining 2 patients, the amount of C4 increased preceding a flare-up of the disease. The measurement of urinary C4 may be useful in evaluating the disease activity of SLE in individual patients and sometimes in predicting the flare-up of the disease. The specific hemolytic activity of excreted C4 and Western blotting analysis showed that urinary C4 consisted mainly of degraded fragments of C4. In two cases, camostat, a serine protease inhibitor, rapidly decreased the urinary C4 excretion, suggesting that the complement activation occurred in the glomerulus in lupus nephritis.