Erythrocyte superoxide dismutase in various hematological diseases

We measured superoxide scavenging activity (SSA) of erythrocytes with the recently developed chemiluminescence method by Nakano et al in Down syndrome and various hematological diseases. Hematological disorders were aplastic anemia, myelodysplastic syndrome, multiple myeloma, malignant lymphoma and chronic myelogenous leukemia. The SSA of erythrocytes was 1.7 times higher in Down syndrome, which was consistent with values reported in the previous publications. The erythrocyte SSA in patients of multiple myeloma treated with interferon-alpha was higher than that in healthy volunteers. The erythrocyte SSA in myelodysplastic syndrome, malignant lymphoma and chronic myelogenous leukemia did not differ from that in healthy volunteers. The mean value of erythrocyte SSA in aplastic anemia also remained within normal range. However, when an individual's hemoglobin concentration was compared with his or her own erythrocyte SSA, there was a clear correlation between them. Namely erythrocyte SSA increased when anemia was severe. There was no correlation between erythrocyte SOD activity and ageing.

[Regulation of coagulo-fibrinolytic activity and lupus anticoagulants in systemic lupus erythematosus]

We determined the following coagulo-fibrinolytic activities in 24 patients with systemic lupus erythematosus (SLE) and 20 healthy adults: prothrombin time (PT), activated partial thromboplastin time (A-PTT), factor VIII: coagulant activity), von Willebrand factor antigen (vWF: Ag), antithrombin-III (AT-III), plasminogen (PLG), alpha 2 plasmin inhibitor (alpha 2 PI), alpha 2-plasmin inhibitor-plasmin complex (PIC), protein C (PC: activity and antigen concentration), and protein S (PS: total PS and free PS). PLG, AT-III, PC antigen concentration and total PS were significantly decreased in ten female controls as compared with ten male controls. Therefore, we used the ten healthy females as controls and excluded two male SLE patients in the analysis of the correlations of coagulo-fibrinolytic activities with lupus anticoagulant (LA), clinical and laboratory features in 22 female patients with SLE. In the SLE patients, PT was significantly shortened, while A-PTT was prolonged. PLG, PC activity and antigen, and total PS were significantly increased, and free PS levels were decreased in SLE. The shortened PT and decreased free PS suggest hypercoagulable states in SLE patients. A significant prolongation of A-PTT and a decrease of F VIII activity were observed in the six LA-positive SLE patients, and the results were considered as known effects of LA. Furthermore, vWF: Ag, AT-III and PC antigen levels were significantly increased in the LA-positive patients as compared with LA-negative patients. These changes indicate both vascular endothelial cell damages and a compensatory increase in coagulation inhibitors in the LA-positive patients.

[Methylprednisolone-pulse therapy in a patient with rheumatoid arthritis and diffuse interstitial pneumonia/pulmonary fibrosis]

A forty-eight year-old female with rheumatoid arthritis developed cough, sputum and dyspnea. Chest X-ray film demonstrated bilateral diffuse interstitial pneumonia and pulmonary fibrosis. Laboratory findings were as follows: ESR 29 mm/h, CRP 3.86 mg/dl, RA test (+), RAHA (-) and WBC 7200/mm3. Marked hypoxemia (po(2)45 Torr) was demonstrated by blood gas analysis. Asymptomatic pulmonary fibrotic lesions which preceded articular symptoms were identified on her previous chest X-ray films. Methylprednisolone-pulse therapy (1g/day, for 3 days) was repeated three times with a 2-week interval. The treatment rapidly improved both pulmonary symptoms and chest X-ray findings. Although the fibrotic shadows on chest X-ray did not completely disappear, her conditions have been maintained well under the treatment with prednisolone (10mg/day) plus D-penicillamine (200mg/day).

Expression of MHC class II antigens and other T cell activation antigens on T cells and salivary duct epithelial cells in the salivary gland of cases of Sjögren's syndrome

We studied infiltrating T cells and salivary duct epithelial cells in the sublingual glands of 10 patients with primary Sjögren's syndrome (SS) using monoclonal antibodies (MoAb) to T cell subsets (OKT-series), natural killer cells (Leu7) and activation antigens of T cells such as OKT10, OKT9, interleukin 2 receptor (anti-Tac antibody) and major histocompatibility complex (MHC) class II antigens (anti-DR and anti-DQ antigens). DR antigens were identified on salivary duct epithelial cells, suggesting that the cells might function as antigen-presenting cells (APC). Among the salivary duct epithelial cells, OKT8+ cells, which are known to be suppressor/cytotoxic cells, were found in 9 out of 10 patients. Three types of mononuclear cell infiltrations were also evaluated separately: (1) periductal foci, (2) periacinal foci and (3) lymph follicles. We found that the majority of the infiltrating cells in the central portion of the periductal foci were activated T cells (OKT3+, OKT4+, OKIa-1+, DR+ and DQ+), but OKT9, OKT10 and Tac antigens were rarely found in this portion. However, most of the infiltrating cells in the peripheral portion of the periductal foci were OKT10+, and some of them were also positive for OKT9 antigen (transferrin receptor). The results indicated that the T cells in the peripheral portion of the periductal foci are at an early or intermediate phase of activation, whereas the T cells around the salivary ducts are at a later phase. Infiltrating cells in the periacinal foci resembled the cells on the peripheral portion of the periductal foci. Cells within lymph follicles were mainly B cells although scattered OKT4+ or OKT8+ cells were also present.

A case of Cushing's disease successfully treated with bromocriptine

A case of Cushing's disease is reported. The administration of bromocriptine was extremely effective in reducing excessive adrenocorticotrophic hormone (ACTH) and cortisol in the blood, which were previously not suppressed by 8 mg dexamethasone and persisted even after removal of the ACTH-producing adenoma in the hypophysis.

Alterations of glomerular filtration rate during cold exposure in progressive systemic sclerosis: measurement with technetium-99m DTPA

We investigated the changes of the glomerular filtration rate (GFR) that occurred when the right hand was soaked in 7 degrees C water. The subjects were 5 patients with progressive systemic sclerosis who did not have clinical evidence of renal involvement. The clearance rate constant of 99mTc-DTPA, which is excreted by glomerular filtration, was measured with a cadmium telluride detector placed over the chest wall. In response to the cold exposure, the constant rose in 2 patients and remained unchanged in the remaining 3 patients. After termination of cold exposure, the constant fell in all 5 patients, suggesting renal Raynaud's phenomenon. These findings suggest that the renal vasculature in these patients has an abnormal response to cold exposure.

[Acute renal failure following dehydration and hemolytic crisis due to pneumonia in a case of PNH]

A 41-year-old female, who had been diagnosed as having paroxysmal nocturnal hemoglobinuria (PNH) in 1985, was admitted to our hospital with cough, fever, diarrhea, vomiting and palpitation in April 1988. The chest X-ray showed pneumonia in her right lung. In the peripheral blood, red blood cell count was 1.64 x 10(6)/microliters, hemoglobin 4.7 g/dl and reticulocytes 19%. The levels of serum LDH, indirect bilirubin and creatinine were high. Pneumonia improved by the administration of antibiotics, however, anemia and renal failure deteriorated. After washed red blood cell transfusions totalling 2,000 ml and six times of hemodialysis, renal function returned to normal. This patient with PNH appeared to have developed acute renal failure by dehydration and hemolytic crisis due to pneumonia.

Transformation of refractory anemia with excess of blasts into acute myelogenous leukemia with Ph-negative chronic myelogenous leukemia-like characteristics

We report a 56 year old patient with acute myelogenous leukemia (FAB classification: M2), in whom the number of mature myeloid cells similar to those seen in Ph-negative chronic myelogenous leukemia increased markedly 2 months after the diagnosis of refractory anemia with excess of blasts (RAEB). This is a rare case of leukemic evolution as a terminal event of RAEB.

Lymphocyte subsets of the peripheral blood in myasthenia gravis determined by two-color flow cytometry

Lymphocyte subsets of the peripheral blood in 43 patients with myasthenia gravis (MG) were determined by two-color flow cytometry using a number of monoclonal antibodies. In the MG patients without thymectomy (Tx) and prednisolone (PSL) treatment, lymphocyte counts, B-cells, CD4+ cells and their subsets were normal, but numbers of T-cells, CD8+ cells and CD8+ CD 11-subsets were significantly decreased. Furthermore, proportions of activated cells in T-cells, CD 16+ Leu7- and CD16+ Leu7+ NK subsets were significantly high in the patients. The changes in T-cells, CD8+ cells and activated T-cells were less marked in the MG patients than Sjögren's syndrome (SS) used as a disease control. Contrary to MG patients, lymphocyte counts, CD4+ cells and their subsets were decreased, and the proportions of B-cells were high in SS patients. These results suggest altered immunologic conditions, immunologically active and deficient conditions, in both diseases, although the alterations were more prominent in SS than MG. PSL treatments and Tx significantly altered the lymphocyte profiles: PSL decreased lymphocytes, B-cells, T-cells, CD4+ cells and their subsets, while the proportions of CD8+ cells were increased. The changes were compatible with the known immunosuppressive effects of PSL. After Tx, lymphocytes and B-cells decreased, but the proportions of T-cells, CD8+ cells and their subsets, and NK cells subsets returned toward normal. CD4+ CD8+ cells were not increased in MG patients, and the cells did not decrease after Tx. Some of these observations might be relevant to clinical effects of Tx, although the mechanism responsible for these changes is still unknown.

Superoxide scavenging activity of BG-104 before and after sonication--determined by ESR spin trapping method

BG-104 is a compound of Chinese herbs which were treated with infrared ray-heating and brewed with microorganisms resulting in activation of actual principles contained in the herbs, and its effectiveness has been reported on various inflammatory disorders such as Behcet's disease, rheumatoid arthritis, bacterial infections and so on. In addition, it is noted as an effective agent to retard cancer progress. This report shows a superoxide scavenging activity of BG-104 using an ESR spin trapping method. For the measurement of superoxide scavenging activity, recombinant human superoxide dismutase is used as a standard. Superoxide scavenging activity of BG-104 increases in a dose-dependent manner and activity is significantly augmented by its sonication.

Increase in pulmonary blood flow during cold stimulation of the mouth in patients with systemic lupus erythematosus

To determine whether pulmonary blood flow is altered by cold stimulation of the mouth, a cold stimulus was induced by having 11 systemic lupus erythematosus patients without pulmonary fibrosis hold ice in their mouths. Lung perfusion was measured by continuous venous infusion of Krypton-81m. During the period in which the ice was held in the mouth, 2 patients showed 32% and 41% increase in pulmonary blood flow. After the cold stimulus was removed, pulmonary blood flow recovered in these patients to within the control range by a margin commensurate with the increase in the duration of the cold stimulus, suggesting that the response may be due to an abnormal reflex of the autonomic nervous system.

Kinetics of indium-111 chloride in chronic myelogenous leukaemia

Indium-111 (111In) bound to transferrin incorporates transferrin receptors which emerge onto the cell membrane of leukaemic cells that have entered into the proliferative status. This study was undertaken to evaluate the kinetics of 111In chloride by counting blood cell radioactivity in five cases of chronic myelogenous leukaemia (CML). Leucocyte radioactivities reached a peak on the third to ninth day after 111In injection. In one case of mild leucocytosis in the early stage of the chronic phase, leucocyte activity was less than 14% of whole blood cell activity throughout the 14 day period. In two cases in the progressive stage of the chronic phase, and in two cases of blast crisis, 44 to 98% of whole blood cell activity at 48 h after 111In injection was occupied by the leucocyte fraction. Platelet radioactivities revealed maximum counts of only 0.1 to 0.4% of the injected dose on the sixth to tenth day. Accordingly, conventional marrow scintigraphy 48 h after 111In chloride injection seems to depict distribution of myelopoiesis rather than erythropoiesis in the progressive stage of the chronic phase and blast crisis in CML in addition to phagocytosis of 111In colloid by reticuloendothelial system.

[The thymus and blood]

The thymic epithelium educate the pre-T lymphocytes from bone marrow by either direct contact or humoral stimulation and support their differentiation, proliferation and maturation. Thymic abnormalities include pathological involution, germinal center formation and tumor. Historically, many disorders associated with thymic abnormality have been reported. In this lecture, the structures and functions of human thymus, and immunological and hematological disorders related to thymic abnormalities such as myasthenia gravis, pure red cell aplasia, immunodeficiency syndromes, immunoglobulin dyscrasias, acute T cell-leukemia, Hodgkin disease and lymphocytic lymphoma were reviewed. These extensive reviews suggested "Pharyngeal Pouch Syndrome" and it's significant roles in hematology.

[A case of lupus nephritis resistant to steroid pulse therapy markedly improved by bolus intravenous cyclophosphamide therapy]

Bolus intravenous cyclophosphamide therapy (IVCY) has recently been the subject of considerable attention because it is occasionally very effective in the treatment of severe lupus nephritis. However only a few reports on this form of therapy have been noted in Japan. Described here is a patient with lupus nephritis accompanied by multi-organ disorders resistant to various therapies including methylprednisolone pulse therapy which responded dramatically to IVCY. The patient, a 37-year-old woman with a history of systemic lupus erythematosus (SLE) starting in 1984, was admitted to our hospital with increasing generalized edema and malaise in January 1987. Evaluation revealed hypoalbuminemia, hypoxemia, ascites, hypocomplementemia and leukopenia. The patient was treated with high-dose oral prednisolone, however the lupus nephritis deteriorated and a high urinary protein level, massive ascites, and pericardial and pleural effusions were noted. Involvement of the central nervous system (CNS) was also observed. Subsequently, she was treated with intravenous methylprednisolone pulse therapy and low-dose oral cyclophosphamide. As her disease was refractory to these treatments IVCY was initiated in May 1987, at a dose 0.5-0.8 g/m2. A total of 3 doses were given, and treatment was discontinued in October 1987 because of marked clinical improvement. After the final IVCY treatment she was discharged, and her subsequent clinical course over a year with a maintenance dose of prednisolone has been uneventful. Thus, IVCY seemed to be useful in the treatment of severe lupus nephritis. More rigorous comparisons of IVCY with other therapies are necessary.

Alteration in pulmonary blood flow induced by cold exposure to the hand in progressive systemic sclerosis

To determine whether pulmonary blood flow is altered by cold exposure to the hand, cold exposure was induced by immersion of the left hand in 7 degrees C water in 8 patients with progressive systemic sclerosis (PSS). Lung perfusion was measured by continuous infusion of 81M krypton into the right antecubital vein. Exposing the left hand to cold caused an 11 to 32% decrease in the pulmonary blood flow in all lung fields in 4 of 8 patients. After release of cold exposure, in one of the 4 patients demonstrating a decrease during cold exposure, pulmonary blood flow recovered, while it kept on a decrease in the remaining 3 patients. Physiological abnormalities of pulmonary blood flow in PSS have been shown as a quantitative change and a image.

Recurrent lupus pneumonitis with pulmonary hemorrhage in systemic lupus erythematosus associated with chronic thyroiditis and antithyroid hormone autoantibodies

We describe a SLE patient with repeated lupus pneumonitis and pulmonary hemorrhage. The hemorrhagic episodes were considered to be related to thrombocytopenia and lupus pneumonitis, which have responded well to treatment with moderate doses of steroids and immunosuppressant. She was also found to be suffering from chronic thyroiditis (hypothyroidism) and was positive for anti-thyroid hormone antibodies, which have not been reported before in the SLE patients with thyroid diseases.

[Abnormalities in the regulation of erythropoiesis by bone marrow fibroblasts in aplastic anemia]

The influence of bone marrow fibroblasts in healthy subjects and patients with aplastic anemia on normal erythroid colony formation was studied using the methylcellulose method. These fibroblasts were treated with methylprednisolone as well. Bone marrow fibroblasts of healthy subjects and patients with aplastic anemia, and the supernatant of their conditioned medium significantly inhibited normal erythroid colony formation. A significantly marked inhibition of normal erythroid colony formation was observed of bone marrow fibroblasts (or the conditioned medium) of the aplastic anemia, when compared with that of the bone marrow of healthy subject fibroblasts (or the conditioned medium). By treating both groups of the bone marrow fibroblasts with methylprednisolone the inhibition was slightly improved. From the above experimental results, it was suggested that the bone marrow fibroblasts and the conditioned medium inhibited normal erythroid colony formation through humoral factors secreted by the fibroblasts, and through contact between the fibroblasts and erythroid colony formation cells.

Lymphocyte subsets of the peripheral blood in Sjögren's syndrome and rheumatoid arthritis

Lymphocyte subsets were determined in the peripheral blood from twenty-three patients with primary Sjögren's syndrome (SS) and sixteen patients with clinically active rheumatoid arthritis (RA) by two-color flowcytometry using various monoclonal antibodies. In both diseases, T-cells (CD3+), suppressor/cytotoxic cells (CD8+) and their cytotoxic subset (CD8+CD11-) were decreased, as compared with thirty-one healthy controls. B-cells (CD 21+ and CD 3-DR+) and activated T-cells (CD 3+DR+) were increased in SS patients. Helper T-cells (CD 4+Leu8-), suppressor-inducer T-cells (CD4+Leu8+), suppressor T-cells (CD8+Leu 15+) and three natural killer (NK) cell subsets determined by both CD16 and Leu7 antibodies did not differ between controls and SS or RA, although Leu7+NK cells were significantly increased in SS patients. In addition, we found that the treatment with low-dose prednisolone decreased B-cells and suppressor-inducer T cells, and increased suppressor T-cells, cytotoxic T-cells and Leu7+NK cells. The results indicate similar changes in the proportion of lymphocyte subsets and suggest immunologically activated and deficient conditions in both diseases. Immunomodulating effects of the treatment with low-dose prednisolone on some of the lymphocyte subsets in patients with these diseases were also supported by the study.

Clinical trial of ambroxol (Mucosolvan) in Sjögren's syndrome

A clinical trial is described in which twelve patients with Sjögren's Syndrome (SS) were given a dose of 135 mg ambroxol (Mucosolvan) daily for eight weeks. Nine of the patients completed the trial. Three patients dropped out because they developed side effects (generalized rashes in two patients and stomatitis in one). The side effects, however, were mild and cleared off after cessation of treatment. Ambroxol improved sicca symptoms, especially ocular symptoms, in the SS patients, although lacrimal and salivary gland functions measured by Schirmer test or gum test were not changed. Furthermore, the treatment did not alter any chemical findings determined in the stimulated tear and saliva. Our results suggest that ambroxol is useful for the management of sicca symptoms in some patients with SS.

Prospective studies on the progress of sicca symptoms in Sjögren's syndrome: subclinical disease develops into the clinical syndrome

We evaluated prospectively twenty-two subjective sicca features in seventeen patients with Sjögren's syndrome (SS) including six patients with primary SS twice at a six-year interval. In the second evaluation in 1986, the frequency of sicca symptoms was increased for most items, and the mean number of positive symptoms was also increased in the patients compared with the results in 1980. In the first evaluation, three patients lacked any sicca symptoms, and were considered as subclinical SS. Sicca symptoms developed in all three of these patients later. A positive correlation between the number of sicca symptoms and the patients' age was also reconfirmed by the present study. Changes in sicca symptoms between the two evaluations were not correlated with objective findings of exocrine gland involvement determined at the time of diagnosis of SS. The lacrimal or salivary secretion and sialographic findings determined serially were relatively stable during whole observation period, except in some patients. The results indicate that both the symptoms and objective findings of glandular involvement progress very slowly in SS, although patients with subclinical disease eventually develop clinical SS.

Increased superoxide production by mononuclear cells of patients with hypertriglyceridemia and diabetes

Diabetic patients with hypertriglyceridemia frequently develop atherosclerosis. Because superoxide (O2-) is suspected to play an important role in the initiation of atherosclerosis, we investigated whether an abnormal amount of O2- was produced by circulating mononuclear cells of patients with both diabetes mellitus and hypertriglyceridemia. The rate of production of superoxide dismutase-inhibitable O2- was measured when cells were stimulated by either 4 beta-phorbol 12 beta-myristate 13 alpha-acetate (PMA) or by opsonized zymosan (OZ). In addition, the rates of O2- production by mononuclear cells drawn from three other groups (normal, solely diabetic, and solely hypertriglyceridemic) were determined. We found that the rate of O2- production by mononuclear cells from the diabetic hypertriglyceridemic group was significantly higher than that from normal, diabetic, and hypertriglyceridemic groups. When the rates of O2- production by mononuclear cells were plotted against the levels of plasma triglyceride for all individuals tested, they correlated positively (r = .73 in PMA stimulation and r = .79 in OZ stimulation, P less than .01). However, the rate of O2- production did not relate to other parameters, i.e., plasma cholesterol level, hemoglobin A1 level in erythrocytes, and the molar ratio of free cholesterol to phospholipid in mononuclear cells. Thus, we concluded that the observed elevated rate of O2- production in the diabetic hypertriglyceridemic mononuclear cells was a reflection of a hypertriglyceridemic condition and was not unique to the diabetic hypertriglyceridemic condition. Also, O2- may be involved in the pathogenesis of atherosclerosis in diabetic hypertriglyceridemic patients when atherogenic factors specific to diabetes are concomitantly present.