Changes in serum fibrogenesis markers during interferon therapy for chronic hepatitis type C

We serially measured the levels of serum N-terminal peptide of type III procollagen (PIIINP), the 7S domain of type IV collagen (IV-7S), and hyaluronate (HA) before (0 month), at the end (6 months), and 24 weeks after the end of interferon therapy (12 months) in patients with chronic hepatitis type C to estimate the effects of interferon alfa (IFN-alpha) on serum levels of hepatic fibrogenesis markers. One hundred twenty-one patients with chronic hepatitis type C received intramuscular injection of 6 million U of natural IFN-alpha for 24 weeks. Patients were divided into three groups: sustained complete response (CR-S), complete response with rebound (CR-R), and nonresponse (NR). Serum PIIINP, IV-7S, and HA levels were significantly decreased and reached normal levels at 12 months in CR-S; only IV-7S levels were significantly decreased at 12 months in CR-R, whereas these levels remained abnormally high in the NR. These results suggest that IFN-alpha therapy could lower the levels of serum hepatic fibrogenesis markers along with improvements in hepatic inflammation.

Changes in serum fibrogenesis markers during interferon therapy for chronic hepatitis type C

We serially measured the levels of serum N-terminal peptide of type III procollagen (PIIINP), the 7S domain of type IV collagen (IV-7S), and hyaluronate (HA) before (0 month), at the end (6 months), and 24 weeks after the end of interferon therapy (12 months) in patients with chronic hepatitis type C to estimate the effects of interferon alfa (IFN-alpha) on serum levels of hepatic fibrogenesis markers. One hundred twenty-one patients with chronic hepatitis type C received intramuscular injection of 6 million U of natural IFN-alpha for 24 weeks. Patients were divided into three groups: sustained complete response (CR-S), complete response with rebound (CR-R), and nonresponse (NR). Serum PIIINP, IV-7S, and HA levels were significantly decreased and reached normal levels at 12 months in CR-S; only IV-7S levels were significantly decreased at 12 months in CR-R, whereas these levels remained abnormally high in the NR. These results suggest that IFN-alpha therapy could lower the levels of serum hepatic fibrogenesis markers along with improvements in hepatic inflammation.

Oxidative damage to skeletal muscle DNA from patients with mitochondrial encephalomyopathies

To estimate the oxidative damage to skeletal muscle DNA in mitochondrial encephalomyopathies, we studied the amount of 8-hydroxy-deoxyguanosine (8-OH-dG) and the localization of superoxide dismutase (SOD) in the skeletal muscles of patients with progressive external ophthalmoplegia (PEO) or Kearns-Sayre syndrome (KSS). The molar ratio of 8-OH-dG/deoxyguanosine in skeletal muscle from PEO or KSS patients was significantly higher than the control value. The ratio from patients with polymyositis or Duchenne's muscular dystrophy was not significantly elevated. Immunohistochemical staining for both Mn-SOD and Cu,Zn-SOD showed pronounced staining in the subsarcolemmal and intermyofibrillar regions of cytochrome-oxidase-negative ragged red fibers of KSS or PEO muscles. Our findings suggest that overproduction of 8-OH-dG and mitochondrial dysfunction with gene deletions are associated with each other in muscle cells of patients with PEO or KSS, and that free radicals may play an important role in the pathophysiology of mitochondrial encephalomyopathies.

Effects of calcium antagonists on hepatic and systemic hemodynamics in awake portal hypertensive rats

The effects of the calcium antagonists diltiazem and nicardipine on portal pressure and splanchnic blood flow were studied in awake, unrestrained portal hypertensive rats. Portal hypertension was induced in rats by partial portal vein ligation. Hemodynamic measurements were done using the radiolabeled microsphere technique. In portal vein-ligated and sham-operated rats, intraarterial diltiazem and nicardipine reduced mean arterial pressure. No significant changes, however, were observed in portal pressure and cardiac index. In portal vein-ligated rats, diltiazem and nicardipine increased portal tributary blood flow. Portal tributary vascular resistance was also significantly decreased. The decrease in the hepatocollateral vascular resistance prevented an increase in portal pressure. In sham-operated rats, these changes were not observed. It is possible that the vascular responses to calcium antagonists are altered in portal vein-ligated rats. These findings demonstrate that the hemodynamic effects of calcium antagonists occur at two levels. First, the increase in portal tributary blood flow appears to be a selective effect on portal tributary vascular resistance. Secondly, the portal pressure does not increase in parallel with the increase in portal tributary blood flow because of a similar reduction in portocollateral vascular resistance.

Gene structure and chromosomal localization of the mouse NMDA receptor channel subunits

Multiple espilon subunits are major determinants of the diversity of the N-methyl-D-aspartate (NMDA) receptor channel. The four epsilon subunit mRNAs exhibit distinct expression patterns in the brain. In an attempt to elucidate the molecular basis of selective and characteristic expression of the NMDA receptor channel subunits, we have isolated the gene encoding the mouse NMDA receptor epsilon 3 subunit and have determined its structural organization. The epsilon 3 subunit gene spans 17.5 kb and consists of 14 exons. The major transcription start site is 439 bp upstream of the ATG initiation codon as determined by primer extension and S1 nucleas protection analyses. Two polyadenylation sites are 397 (or 398) and 402 bp downstream of the termination codon. The 5'-flanking region of the epsilon 3 subunit gene contains GC-rich segments including consensus sequences for binding of the transcription factors Spl and EGR-1. The murine chromosomal locations of the five NMDA receptor channel subunits, the epsilon 1 (Grin2a), epsilon 2 (Grin2b), epsilon 3 (Grin2c), epsilon 4 (Grin2d) and zeta 1 (Grinl) subunits, were determined using an interspecific backcross mapping panel derived from crosses of [(C57BL/6JxM. spretus) F1xC57BL/6J] mice. Each of these genes mapped to a single chromosome location. The mapping results assigned the five loci to five different mouse autosomes, indicating that they have become well dispersed among mouse chromosomes.

[Endobronchial malignant lymphoma of mucosa-associated lymphoid tissue]

A 56-year-old man presented with pulmonary infiltrates. A chest roentgenogram revealed infiltrates in the left upper lobe and a tomogram showed obstruction of the left upper lobe bronchus. Computed tomography of the chest confirmed the presence these infiltrates, and no lymphadenopathy or mediastinal involvement was detected. At bronchoscopic examination, endobronchial masses were found. These masses almost completely obstructed the distal portion of the left upper lobe bronchus and partly obstructed the right upper lobe bronchus. A left upper sleeve lobectomy was done. Macroscopically, the tumor mass looked like a polypoid growth in the bronchial lumen. Microscopic examination showed that the tumor was composed mainly of small cleaved cells. These cells were observed to have infiltrated the epithelium to form lymphoepithelial lesions. Their B-cell origin was shown by the positive CD19 stain. Monoclonality of tumor cells was shown immunohistochemically and by hybridization techniques. Evidence of monoclonal B-cell proliferation was found in the rearrangement of Ig heavy- and light-chain genes, with Bam HI and Hind III digests. The final diagnosis was distinctive B-cell lymphoma (diffuse, small cell type) of mucosa-associated lymphoid tissue.

Determination of the beta-blocker carteolol in human plasma by a sensitive gas chromatographic-negative-ion chemical ionization high-resolution mass spectrometric method

A specific and sensitive gas chromatographic-high-resolution mass spectrometric method for the determination of 5-(3-tert.-butylamino-2-hydroxy)propoxy-3,4-dihydrocarbostyril (carteolol), which is a beta-blocker giving depression of intraocular pressure, was developed to elucidate the pharmacokinetics of its ophthalmic application. Carteolol has been determined by high-performance liquid chromatography but with less satisfactory sensitivity. Carteolol was derivatized with pentafluorobenzoyl (PFB) amide followed by dimethylethylsilyl (DMES) ether, resulting in a high negative-ion current. The PFB-DMES derivative of carteolol was determined by the gas chromatography-negative-ion chemical ionization mass spectrometry (GC-NICI-MS) using selected-ion monitoring at low and high mass spectrometric resolution. the detection limit was less than 100 fg when the fragment ion was monitored at m/z 552.2067 in the NICI mode using methane as a reagent gas. The quantification limit of carteolol in human plasma with this method was less than 30 pg/ml. The proposed GC-MS method is considered to have sufficient specificity and sensitivity to study the pharmacokinetics of carteolol used as an ophthalmic solution.

[Primary lung cancer presenting as spontaneous pneumothorax]

Pneumothorax is a rare manifestation of lung cancer. The mechanism by which pneumothorax occurs in lung cancer is not clear, and differing views have been expressed. Among 180 adults who presented with spontaneous pneumothorax from 1980 to 1992, eight had lung cancer: seven had squamous cell carcinoma and one had adenocarcinoma. All were men between 50 and 81 years old (average age, 66 years). In all patients, the pneumothorax occurred on the same side as the carcinoma. Thoracotomy was done in four patients. The results obtained by surgery indicated that pneumothorax may be caused by: 1) direct invasion of tumor into the pleura (patient 1); 2) rupture into the pleural space of dilated alveoli that are distal to the site of stenotic bronchial cancer (patient 7); 3) rupture into the pleural space of alveoli that had become distended to compensate for atelectasis due to obstructive bronchial cancer (patient 6); and 4) unknown (patient 2). These results suggest that lung cancer should always be considered as a possible cause of spontaneous pneumothorax in older patients.

Subcutaneous mastectomy with axillary dissection plus breast reconstruction using latissimus dorsi myocutaneous flap (or latissimus dorsi muscle) for breast cancer

Subcutaneous mastectomy with axillary dissection plus breast reconstruction using latissimus dorsi myocutaneous flap (or latissimus dorsi muscle) was carried out for 8 patients with breast cancer. These consisted of 1 patient with non-invasive ductal carcinoma, 5 with stage I (4 invasive ductal carcinomas and 1 invasive lobular carcinoma) and 2 with stage II (1 invasive ductal carcinoma and 1 invasive lobular carcinoma). Cancer cells were recognized histopathologically in the resection margins of the small mammary gland resting under the nipple in only 1 case, and the remaining 7 cases underwent a curative resection. In the prognosis, 7 patients were disease-free and 1 showed a local recurrence. The patient with local recurrence showed no metastasis after the resection of the local lesion. The cosmetic results of this operation were excellent in all patients. This operation was effective both for these patients with breast cancer who did not want to undergo breast conserving surgery or modified radical mastectomy and for those who were excluded from the criteria of breast conserving surgery from the prognostic and cosmetic points of view.

[Single administration toxicity studies of T-3761 in mice, rats and dogs]

Single dose toxicity studies of T-3761 were carried out in mice, rats and dogs, and the following results were obtained. 1. The approximate lethal dose of T-3761 were more than 5,000 mg/kg for mice and rats, more than 2,000 mg/kg for dogs with oral administration, and more than 5,000 mg/kg for mice and rats with subcutaneous injection. LD50 values with intravenous injection were 783 mg/kg for male mice, 832 mg/kg for female mice, 341 mg/kg for male rats, and 403 mg/kg for female rats. Two dogs given 200 mg/kg did not die but one of the two treated with 400 mg/kg died after intravenous injection. The approximate lethal dose for dog was 400 mg/kg. 2. Neither abnormal symptoms and macroscopic findings nor deaths were observed in mice and rats treated orally. Granuloma around precipitates of T-3761 at the injection site was seen in mice and rats injected subcutaneously. Slight increase of white blood cell count, serum GOT, CPK and urea nitrogen were transiently found in dogs treated orally. Neither abnormal macroscopic findings nor deaths were observed in dogs treated orally. 3. Decreased motor activity and irregular breathing were observed in mice and rats injected intravenously. In dying animals, tonic or clonic convulsions were observed. Vomiting, hyperemia of ophthalmic mucosa, edema of face, decrease of motor activity, salivation and decrease in body temperature were observed in dogs injected intravenously. At higher doses, scream and tachypnea were observed while injecting. Hematological examinations disclosed that increases in red blood cell count, white blood cell count, hematocrit and hemoglobin were found transiently. In biochemical examinations, increases in serum GOT, GPT, urea nitrogen and creatinine were found transiently. One dog intravenously injected 400 mg/kg, showed tonic convulsion and died.

[Three months oral repeated dose toxicity of T-3761 in beagle dogs]

A three months oral repeated dose toxicity study was carried out in beagle dogs at dosages of 300, 100, 30 and 10 mg/kg, respectively. The following results were obtained. 1. There was no death of animals during administration at any dose levels. A few to all animals in all T-3761 treated groups complained of pain at the time of extension of limbs. 2. Mild decrease of body weight was observed in 1 of the 10 animals at 300 mg/kg and 1 of the 8 animals at 100 mg/kg, respectively. 3. In urinalysis, crystals which seemed to be the test compound in the urinary sediment, were observed in 5 of the 10 animals at 300 mg/kg and 4 of the 8 animals at 100 mg/kg, respectively. 4. In blood biochemical examination, mild elevation of GPT was observed in 1 of the 10 animals at 300 mg/kg. Increase of A/G ratio was observed in males at 300, 100 and 30 mg/kg, and females at all dose levels. 5. In macroscopic findings at necropsy, blister and erosion were observed at articular cartilage of shoulder, elbow, hip, and/or knee joints in all animals at 300 and 100 mg/kg, 7 of the 8 animals at 30 mg/kg and 1 of the 8 animals at 10 mg/kg. 6. No toxic dose level was less than 10 mg/kg/day in this study.

[Three months oral repeated dose toxicity of T-3761 in rats]

A three months oral repeated dose toxicity study was carried out in rats at dosages of 1,500, 400, 100 and 25 mg/kg. The following results were obtained. 1. There was no dead rat caused by administration of T-3761. Soft feces were observed in male and female rats at 1,500 mg/kg. Body weight gain was slightly suppressed in male rats at 1,500 mg/kg. 2. Crystals which seemed to be test compound in the urinary sediment, were observed in male and female rats at 1,500 and 400 mg/kg. 3. There was no abnormality caused by administration of T-3761 in both hematological and ophthalmological examination. 4. Mild increase in total cholesterol (males and females in 1,500 mg/kg group, females at 400 mg/kg group), phospholipids (males at 1,500 mg/kg group) and A/G ratio (males and females in all treated groups) were observed. However, these biochemical changes were reversible in the recovery period. 5. Dilatation of the cecal lumen was observed in male and/or female rats at 1,500, 400, 100 mg/kg. However, no histological abnormalities were seen in the mucosa of cecum. 6. Blister and erosion were observed at articular cartilage of knee or hip joints in 2 of the 19 rats at 1,500 mg/kg, 1 of the 9 rats at 1,500 mg/kg of recovery study and 3 of the 10 rats at 400 mg/kg of recovery study. 7. No toxic dose level was regarded to be 100 mg/kg/day in this study.

[Phototoxicity and photoallergenicity tests of T-3761]

Phototoxicity and photoallergenicity tests of T-3761 (oral or percutaneous administration) were carried out in guinea pigs. Phototoxicity test of T-3761 (oral administration) was done in rats, too. The following results were obtained. 1. Compared with comparative drugs in oral administration, phototoxicity of T-3761 was equal to that of ciprofloxacin, slightly stronger than that of nalidixic acid and weaker than those of ofloxacin, enoxacin, sparfloxacin and lomefloxacin. 2. A sensibility to phototoxicity of T-3761 in rats was weaker than that in guinea pigs. 3. Phototoxicity and photoallergenicity were not observed in application of T-3761 as 10% ointment. 4. Photoallergenicity was not observed in oral administration of T-3761.

Systemic artery-to-pulmonary artery shunt after using an omental pedicle flap

A 66-year-old man was hospitalized because of hemoptysis. Four years earlier, he had undergone an operation involving the use of an omental pedicle flap that was supplied by the right gastroepiploic artery for the treatment of empyema. Arteriography revealed that the right gastroepiploic artery communicated with the periphery of the right pulmonary artery. The right gastroepiploic artery was divided surgically.

[Female lung cancer]

One hundred and ninety one women were diagnosed with lung cancer at our hospital. This comprised 23.7% of all lung cancer cases. Smoking habits were significantly lower in female lung cancer. Adenocarcinoma is the most common histological type of female lung cancer (64.2%). The prognoses of asymptomatic cases detected by regular examination were significantly better than those of symptomatic cases. Among resectable cases of either adenocarcinoma or squamous cell carcinoma, there were no significant differences between the prognosis for women and that for men. However, the prognosis for nonresectable cases of adenocarcinoma in women was significantly better in the 2-year survival rate (30.8%) than the prognosis for such cases in men. Since the periphery type is the most common site of adenocarcinoma in women, educating women, especially those in the high-risk group, and persuading them to undergo regular examinations are important step to increasing early-stage detection and cure.

[Trial of self-management of outpatients with implanted reservoir for arterial infusion of anticancer drugs]

We attempted to instruct the outpatients with malignant liver tumor (metastatic liver cancer and advanced hepatocellular carcinoma) who received intermittent arterial infusion chemotherapy using implanted reservoir to detach the devices for arterial infusion by themselves at home. All patients who received our instruction could master self-detachment at home, which shortened the hospitalized day. And patients' desire for this treatment promoted with improvement of the recognition of their families to participate in treatment together. We experienced no trouble which disturb the treatment. This methods was considered to promote the improvement of QOL of these patients.

Invasive ductal carcinoma with a predominant intraductal component arising in a fibroadenoma of the breast

A rare case of invasive ductal carcinoma with a predominant intraductal component arising within a fibroadenoma of the breast in a 42 year old Japanese female was investigated by light microscopy. The patient, who had a well-defined, rubbery breast tumor measuring 2.0 x 3.0 cm, had undergone a tumorectomy 21 months after she noticed the tumor. Histologically, the fundamental architecture of the tumor showed an intracanalicular-type of fibroadenoma, but extensive proliferation of atypical cells was noticed in the lumen of the ducts. Tumor cells in the canaliculi had characteristics of ductal carcinoma, such as solid, comedo and cribriform patterns. As most of the ducts were occupied by carcinoma cells with several foci of microinvasion in the stroma of the fibroadenoma, it was diagnosed as invasive ductal carcinoma with a predominant intraductal component arising within a fibroadenoma. This coexistence of in situ proliferation and invasive lesions of carcinoma within a fibroadenoma suggest the origin of the carcinoma to have been in the epithelial component of the fibroadenoma. In addition, this study clarifies the fact that carcinoma cells may proliferate and spread along the lumen of pre-existing ducts of the fibroadenoma and speculates that the duct system of the fibroadenoma has complete continuity.

4-acylaminophenol derivatives as novel lipoxygenase inhibitors: synthesis and inhibitory effect on 5-lipoxygenase and leukotriene B4 production

Structure-activity relationships in the inhibitory effects of 4-acylaminophenol derivatives on the 5-lipoxygenase (5-LOX) from RBL-1 cells and leukotriene B4 (LTB4) production by guinea pig neutrophils were studied. When the N-acyl group was n-octanoyl or 2-thiophenecarbonyl and the size of the two ortho substituents of phenol was varied, the substituents bulkier than isopropyl, i.e., 2,6-di-tert-butyl and 2,6-dicyclohexyl, substantially weakened the inhibitory activity in both enzymatic and cellular systems. Among the 2,6-dimethyl derivatives with an acyl group of various carbon-chain lengths (C1-13), those with a n-alkyl chain of C5 to C12 showed similarly potent inhibitory activities toward 5-LOX with an IC50 ranging from 0.27 to 0.66 microM; in contrast, maximal inhibitory activities toward LTB4 production were observed in a narrower range of the serial compounds: i.e., those with a n-hexyl, n-heptyl, or n-octyl chain on the carbonyl carbon formed by far the most inhibitory group of the series and the inhibitory activity sharply decreased on either side of the chain length. Nearly all the active compounds also inhibited cyclooxygenase (COX), but the IC50 values for COX inhibition were more than ten times higher than the corresponding IC50 values for 5-LOX inhibition in most cases, indicating that the acylaminophenols are relatively selective 5-LOX inhibitors.

Differences of LAK-activity and IL-2 responsiveness between alpha/beta and gamma/delta T cells which developed after thymus transplantation

A patient with severe combined immunodeficiency was transplanted with T cell depleted haploidentical bone marrow from his father and was later given a thymic graft from an unrelated donor. alpha/beta and gamma/delta T cells of bone marrow donor origin appeared only after the thymus transplantation procedure. Among the peripheral blood lymphocytes (PBL), gamma/delta T cells comprised 10-20% and most of them were delta TCS1+. The alpha/beta T cells were single positive cells, either CD4+ or CD8+. Expression of CD5, CD7 and CD8 alpha,beta molecules on alpha/beta T cells was reduced. Functional studies showed that gamma/delta T cells proliferated slightly in response to anti-CD3 stimulation, and proliferated well with exogenous IL-2 stimulation, while alpha/beta T cells did not proliferate following mitogenic stimulation even in the presence of IL-2. gamma/delta T cells but not alpha/beta T cells exhibited some LAK activity after culturing with IL-2. Since alpha/beta T cells expressed IL-2R alpha and beta chains after mitogenic stimulation and bound IL-2, the deficit(s) in these cells was considered to occur after IL-2 binding to the IL-2R. These results indicate thymic dependency of both types of T cells and that two types of T cells differed in the acquisition of IL-2 responsiveness during development.

Pulmonary miliary tuberculosis and T-cell abnormalities in a severe combined immunodeficient patient reconstituted with haploidentical bone marrow transplantation

We report the development of miliary tuberculosis in a 7-year-old boy with severe combined immunodeficiency (SCID), whose immune system had been only partially reconstituted by haploidentical bone marrow transplantation. Although alpha beta and gamma delta T cells were of donor origin, alpha beta T cells in this patient showed defective interleukin-2 (IL-2) production, impaired IL-2 responsiveness and decreased cytolytic activity. However, gamma delta T cells could exhibit enough cytolytic activity after incubation with IL-2. Despite the presence of disseminated infection, C-reactive protein (CRP) remained negative. IL-2 therapy aggravated the disseminated tuberculosis though gamma delta T cells were supposed to be activated, and concurrently CRP became positive. These findings suggest that gamma delta T cells have no more than limited immunological roles in mycobacterium tuberculosis infection.

Purification and characterization of two Kunitz family subtilisin inhibitors from seeds of Canavalia lineata

Two subtilisin inhibitors (CLSI-II and -III) were purified from seeds of Canavalia lineata by extraction with water, ammonium sulfate precipitation, and chromatographies on DEAE-Toyopearl and hydroxyapatite. The two inhibitors have the same molecular weight of about 22,000, and quite similar amino acid compositions. They contain five half-cystine residues and tend to dimerize through an intermolecular disulfide bridge due to the presence of a single cysteine residue. CLSI-III only inhibited subtilisin-type serine proteases, while CLSI-II showed a wider inhibitory specificity. Though the two inhibitors have almost identical thermal labilities, CLSI-II is more stable as to extreme pH than CLSI-III. They are considered to be Kunitz type inhibitors on the basis of several properties.