Preliminary clinical trial of autologous bone marrow transplantation after in vitro monoclonal antibody and complement treatments in null cell-type acute lymphocytic leukemia

Autologous bone marrow transplantation (BMT) in null cell-type acute lymphocytic leukemia (Null-ALL) was carried out after depletion of leukemia cells from transplanted bone marrow. Patients' autologous bone marrow cells were harvested during remission and treated in vitro with complement and three monoclonal antibodies (NL-1, NL-22 and HL-47) reactive to Null-ALL cells, and then cryopreserved. Three patients were transplanted with the antibody-treated bone marrow cells during the first remission period after preconditioning with intensive chemotherapy and total body irradiation, while transplantations in two other patients, who were in poor clinical condition, were done during the fourth remission period and the third relapse, respectively. Good preservation of hematopoietic stem cells after antibody treatment and cryopreservation of bone marrow cells was demonstrated in all five cases studied. Clinically, prompt recovery of white blood cells and platelets was observed in the three patients who received BMT during the first remission period; two of them have continued remission (2 and 15 months), while the other relapsed after 7 months of remission. these results suggested that autologous BMT with these three antibodies may be an effective mode of therapy for Null-ALL patients.

Graft-versus-host disease following allogeneic bone marrow transplantation

Twenty-one patients, 18 with leukemia and three with severe aplastic anemia, were treated by allogeneic bone marrow transplantation. Acute graft-versus-host disease (GVHD) developed in 13 patients (62%), of whom nine (69%) had grade I, two grade II, one grade III and one grade IV. In all nine patients with grade I, elevation of the serum glutamic pyruvic transaminase level without an increase in the serum bilirubin level was observed, which suggested the presence of GVHD in the liver. All 11 patients with grade I and II responded well to therapy with predonisolone. Eleven (73%) of the 15 patients who survived for more than 100 days after marrow transplantation developed chronic GVHD. As signs of chronic GVHD, hepatic disturbances were observed in nine patients (82%), while exanthema, ophthalmic symptoms and oral mucosal symptoms were observed in seven (64%), six (55%) and four (36%), respectively. These symptoms could be well controlled by predonisolone combined with either azathioprine or cyclosporin A. Of the five deaths following the onset of chronic GVHD, three were due to interstitial pneumonitis, one to sepsis and one to relapse of the leukemia. Karnofsky's performance scores of five of the six surviving patients with chronic GVHD were 90%. Six patients with acute leukemia were still alive more than six months after marrow grafting. None of them have shown recurrence of leukemia. Five of these six had chronic GVHD.

Multi-gene structure of the storage protein genes of Sarcophaga peregrina

Three recombinant phages containing chromosomal segments of Sarcophaga peregrina encoding storage protein were isolated. These clones were found to contain sequences hybridized with the messenger RNA of 75,000 Mr protein, a monomer of storage protein. From restriction analysis it was found that message-homologous regions are not identical, and thus are different genes with similar sequences. From the analysis of these clones it was concluded that the storage protein gene belongs to a multi-gene family.

[A case of refractory acute lymphocytic leukemia who achieved a complete remission by mitoxantrone]

A 21-year-old male was diagnosed as having acute lymphocytic leukemia in March 1982. The patient was immediately treated with VENP [vincristine (VCR), Endoxan (EX), Natulan, prednisolone (Pred)] therapy, yielding a partial remission. After one course of AAAP [ACNU, adriamycin (ADM), methotrexate (MTX), Pred] therapy, a combination chemotherapy with behenoyl-arabinocytosine, daunomycin (DM), vindesine and Pred was administered, which produced a complete remission lasting for 52 days. For the relapse, L-Asparaginase (L-Asp) and Pred therapy, large doses of MTX, the combination chemotherapy with VCR, EX, L-Asp and Pred and VEMP (VCR, EX, 6-MP, Pred) therapy were administered consecutively, PR was maintained but CR was not achieved. While receiving the combination chemotherapy consisting of VCR, EX, carbocone and Pred, the leukemic cells of his bone marrow increased gradually and reached to 70%; at that time cumulative doses of DM and ADM reached to 360 mg and 120 mg respectively. Thereafter mitoxantrone (MX) was administered on a 5-day iv schedule using daily dose of 4 mg/m2. Leukopenia was prolonged and liver dysfunction appeared, and they were recovered gradually. Two additional courses of MX using the same schedule and daily dose were given combined with Pred. Prolonged leukopenia and transitional liver dysfunction were also observed. He attained a CR, which was of short duration. It was clinically indicated that MX did not have a complete cross-resistance with many antileukemic agents including DM and ADM.

Differential expression of two abundant messenger RNAs during development of Sarcophaga peregrina

Expression of two abundant mRNAs in the fat body of third instar larvae of Sarcophaga peregrina was studied using genomic clones of storage protein and 25K protein as probes. It was found that these two genes were expressed sequentially in the third instar with a 20-hr interval between their expressions. No amplification of genes was detected during larval development, suggesting that the high level of mRNA was due to efficient transcription. The contents of the two mRNAs in third instar larvae were about the same, although the synthesis of storage protein was much more than that of 25K protein.

[Adriamycin-aclacinomycin therapy (AA therapy) for acute leukemia unresponsive to BH-AC-DMP therapy]

Eight adults with acute non-lymphocytic leukemia refractory to BH-AC.DMP therapy (N4-behenoyl-1-beta-D-arabinofuranosylcytosine, daunomycin, 6-mercaptopurine and prednisolone) were treated with a combination therapy of anthracycline antibiotics: adriamycin and aclacinomycin A (AA therapy). Four of five patients, who had received neither adriamycin nor aclacinomycin A previously, achieved complete remission after one course of AA therapy with a median time to remission of 24.5 days (ranging from 21 to 31 days). Two cases were in first remission induction phase and the other two were in first of third relapse. Three cases still maintain complete remission and the durations of remission range from 3 to over 14 months. Major side effects were loss of hair (100%) and myocardial damage (64%). T wave flattening and appearance of U wave in ECG were noted a few days after receiving chemotherapy but those changes returned to normal within 2 to 3 weeks. Ventricular fibrillation was observed in one case, which was refractory to chemotherapy and complicated by sepsis and electrolytes imbalance. Thus, this regimen deserves to be tried as a remission induction in patients with refractory acute non-lymphocytic leukemia.

Various sulfatase activities in leukocytes and cultured skin fibroblasts from heterozygotes for the multiple sulfatase deficiency (mukosulfatidosis)

In heterozygotes for multiple sulfatase deficiency (MSD), several sulfatase activities including arylsulfatases A, B1, B2, and C, and cholesterol sulfatase were 40-50% of normals in cultured skin fibroblasts and 70-80% of normals in leukocytes. In MSD patients, these enzyme activities were deficient or reduced. DEAE-Sepharose column chromatographic patterns of 4-methylumbelliferyl sulfatases A, B1, and B2 in leukocytes and cultured skin fibroblasts from MSD patients and heterozygotes were also consistent with the above data. These data indicate that several sulfatase activities in heterozygotes of MSD exhibited intermediate activities as observed in the heterozygote state of other autosomal recessive inherited diseases.

Identification of storage-protein messenger RNA of the fleshfly Sarcophaga peregrina

Storage-protein mRNA was found to be abundant in poly(A)-containing RNA extracted from the fat-body of third-instar larvae of Sarcophaga peregrina (fleshfly). This RNA sedimented at the position of 19S on sucrose-density-gradient centrifugation and the product of its translation in vitro was 75K protein (protein of mol.wt. 75 000), which was precipitated specifically with antibody against storage protein. This product was suggested to contain a signal sequence that is missing in mature storage protein. The poly(A)-containing RNA was also found to contain much of another mRNA coding for 25K protein (protein of mol.wt. 25 000), but the function of this protein is unknown.

Prenatal diagnosis of metachromatic leukodystrophy: a diagnosis by amniotic fluid and its confirmation

Late infantile metachromatic leukodystrophy (MLD) was successfully diagnosed in utero by demonstrating the absence of arylsulfatase-A in amniotic fluid using diethylaminoethyl-Sepharose column chromatography. Diagnosis by amniotic fluid using an ion-exchange column is more rapid and reproducible as compared with those reported previously. The diagnosis was confirmed by the absence of arylsulfatase-A in fetal brain, liver, and kidney tissues as well as by the marked accumulation of sulfatide in kidney. The kidney is the most appropriate organ for the demonstration of sulfatide accumulation in fetal tissues in MLD.

Multiple sulfatase deficiency (mucosulfatidosis): impaired degradation of labeled sulfated compounds in cultured skin fibroblasts in vivo

Skin fibroblasts from a Japanese patient with multiple sulfatase deficiency (MSD) (Mucosulfatidosis) were studied with regard to metabolism of various sulfated compounds in vivo. Several sulfatase activities (arylsulfatases A, B and C, cholesterol sulfatase, heparin N-sulfatase) were deficient in skin fibroblasts grown in F-10 CO2 medium. The accumulation and degradation of 35S-sulfatide, 35S-mucopolysaccharides, 14C-cholesterol sulfate by MSD cells were also studied, comparing them to control, Hunter and metachromatic leukodystrophy cells. MSD fibroblasts accumulated and failed to degrade these compounds in vivo. Cholesterol sulfate was also incorporated into the control and pathological cells, and MSD cells were unable to hydrolyze cholesterol sulfate, though cholesterol sulfate is known to be hydrolyzed in the non-lysosomal subfraction. From these data it is clear that multiple enzyme deficiencies in MSD fibroblasts can be demonstrated in vivo.

Syntheses and structure-activity relationships of 6-aryl-4H-s-triazolo[3,4-c]thieno[2,3-e] [1,4]diazepines

A variety of 6-aryl-4H-s-triazolo[3,4-c]thieno-[2,3-e][1,4]diazepines was synthesized and tested for antipentylenetetrazole activity and inhibition of fighting episodes. The structure-activity relationships are discussed. Some compounds were more active than diazepam in the two assays. Among them, 6-(o-chlorophenyl)-8-ethyl-1-methyl-4H-s-triazolo[3,4-c]thieno[2,3-e][1,4]diazepine was found to have favourable properties as an anxiolytic drug with very low toxicity. Clinical studies of this compound (Y-7131) are under way.