Induction of L1 mRNA in PC12 cells by NGF is modulated by cell-cell contact and does not require the high-affinity NGF receptor

We examined the effects of nerve growth factor (NGF) and cell-cell contact on expression of the neural cell adhesion molecule L1 in PC12 cells. After 7 d exposure to NGF, but not after exposure to EGF, FGF, TGF beta, or dibutyryl cAMP (dbcAMP), L1 mRNA levels increased fourfold. This increase was not blocked by K252a, an inhibitor of the high-affinity NGF receptor, although neurite extension was completely inhibited. L1 mRNA levels also increased in NGF-treated mutant PC12 cells (PC12nnr5) that lack the high-affinity NGF receptor. The effect of NGF on L1 mRNA was greatest in cells cultured at high density, but its effect on cells cultured at low density was augmented by antibody to L1 (to mimic L1 homophilic binding). Various extracellular matrix components had no differential effects on L1 mRNA levels in either the presence or absence of NGF. Together, these findings suggest that NGF regulates L1 expression by a mechanism that is independent of the high-affinity NGF receptor and that this regulation is modulated by cell-cell contact but not by cell-extracellular matrix interactions.

CNS myelinogenesis in vitro: time course and pattern of rat oligodendrocyte development

Oligodendrocyte precursor cells that develop into myelin-forming cells of the central nervous system (CNS) were cultured from newborn rat brain to study how they proliferate and differentiate in normal conditioning medium, and their cell development was characterized by scanning electron microscopy (SEM) observation and immunocytochemical studies. We have identified A2B5-negative pre-O2A progenitor cells (so-called "type-1" oligodendrocytes) in the secondary cultures on the astrocyte feeder layer. These cells are very small (diameter: 3.5 microns), round, and glossy, and develop into the process-bearing O2A progenitor cells (called "type-2" oligodendrocytes), which also express myelin basic protein (MBP) both in the cell body and in their cell processes. Finally, they develop into mature oligodendrocytes (called "type-3" oligodendrocytes). After MBP expression is elicited in these cells and MBP accumulates in the cell process in the area in contact with the axon, these cells are capable of forming the myelin sheath. Therefore, we examined the mechanism of myelin-sheath formation of "type-3" oligodendrocytes using video time-lapse movies, and demonstrated that these cells initially sent out processes to search for axons several times before the onset of myelination. Then thick filopodia extended towards the axon, and at the same time, the axonal part of neuron moved forward. Finally the ruffling lamellipodial parts wrapped up the axon similarly to a transverse wave with the secured thick filopodial process on the axon acting as scaffolding. These results suggest that our experimental systems are useful in studying normal oligodendrocyte development and their cellular biochemistry, as well as investigating the mechanism of myelin formation by oligodendrocytes.

Optically active antifungal azoles. IV. Synthesis and antifungal activity of (2R,3R)-3-azolyl-2-(substituted phenyl)-1-(1H-1,2,4-triazol-1-yl)-2-butanols

(2R,3R)-3-Azolyl-2-(substituted phenyl)-1-(1H-1,2,4-triazol-1-yl)-2-butanols (III) were prepared from (2R,3S)-3-methyl-2-(substituted phenyl)-2-(1H-1,2,4-triazol-1-yl)methyloxiranes (21a-f) by a ring-opening reaction with 1H-1,2,3-triazole and 1H-tetrazole and evaluated for antifungal activity against Candida albicans in vitro and in vivo. The optically active oxiranes (21a--f) which serve as the key synthetic intermediates, were synthesized from 1-[(2R)-2-(3,4,5,6-tetrahydro-2H-pyran-2-yl)oxypropanoyl]morpholin e (24) and substituted phenylmagnesium bromide (23) via six steps in a stereocontrolled manner. The 3-(1H-1,2,3,-triazol-1-yl)-(IIIa) and 3-(2H-2-tetrazolyl)-2-butanol (IIId) derivatives showed strong protective effects against candidosis in mice.

[Primary culture of proximal tubular cells (PTC) from normal mouse kidney as an in vitro model to study mechanisms of development of tubulointerstitial nephritis. Induction of ICAM-1 in PTC by antigen-primed lymphocytes]

Cultured PTC clearly expressed intercellular adhesion molecule-1 (ICAM-1) under the influence of tubular basement membrane antigen (TBM)-primed lymphocytes. These TBM-primed lymphocytes also demonstrated a high cytotoxic activity against cultured PTC. A pure preparation of isolated PTC from BALB/c mouse kidney was brought into primary culture. PTC was prepared by the method of Boogaard PJ et al, and our modification. Briefly, kidney was perfused with buffer containing 0.08% (w/v) collagenase. The cortical tissue was then filtered through nylon-gauze. Viable PTC were separated from other materials by isopycnic centrifugation on a discontinuous Nycodenz gradient. The confluent monolayer of PTC showed a typical epithelial morphology with cobblestone-like cells in the center of the cell-islands. Typical dome formation was observed in PTC cultures. These cells also strongly expressed gamma-glutamyl transpeptitase activity. Coculture of PTC with syngeneic lymphocytes primed with TBM antigen induced ICAM-1 expression in PTC. The TBM-primed lymphocytes had a cytotoxic activity without complement. However, neither virgin lymphocytes nor liver antigen-primed lymphocytes had cytotoxic activity. This simple syngeneic experimental model may allow us further molecular biological examination of renal tubulointerstitial diseases.

Optically active antifungal azoles. V. Synthesis and antifungal activity of stereoisomers of 3-azolyl-2-(substituted phenyl)-1-(1H-1,2,4-triazol-1-yl)-2- butanols

The (2S,3S)-, (2R,3S)- and (2S,3R)-stereoisomers of (2R,3R)-3-azolyl-2-(substituted phenyl)-1-(1H-1,2,4-triazol-1-yl)-2-butanols [(2R,3R)-1a--d] were prepared and evaluated for antifungal activity against Candida albicans in vitro and in vivo to clarify the relationships between stereochemistry and biological activities. The results revealed that the in vitro antifungal activity in each set of the four stereoisomers [(2R,3R)-, (2S,3S)-, (2R,3S)- and (2S,3R)-1a--d] definitely paralleled the in vivo antifungal activity against candidosis in mice, and the order of potency was (2R,3R) >> (2R,3S) > or = (2S,3S) > or = (2S,3R). In addition, the four stereoisomers in each set were assessed for sterol biosynthesis-inhibitory activities in C. albicans and rat liver. The (2R,3R)-isomer was found to exert a strong and selective inhibitory effect on the sterol synthesis in C. albicans as compared with that in rat liver.

Effects of hypophysectomy on soleus muscle fibers and spinal motoneurons in rats

The fiber type distribution of the soleus muscle in male and female rats was investigated 4 weeks after hypophysectomy. Oxidative enzyme activity of the soleus motoneurons in the spinal cord was also examined by enzyme histochemical assay. In male rats, the total number of fibers in the soleus muscle was not changed after hypophysectomy, but the percentage of intermediate (INT) fibers (with intermediate adenosine triphosphatase activity following alkaline preincubation, and high succinate dehydrogenase and alpha-glycerophosphate dehydrogenase activities) was increased. All types of fibers in the soleus muscle of hypophysectomized rats showed high adenosine triphosphatase activity following acid preincubation. Oxidative enzyme activity of the motoneurons innervating the soleus muscle was not changed after hypophysectomy. Similar results were obtained in female rats. It is suggested that the increased percentage of INT fibers in the rat soleus muscle after hypophysectomy is due to a lack or reduced levels of growth hormones, and that the metabolic capacities of the muscle fibers and of the innervating motoneurons are affected independently by hypophysectomy.

Antigenicities of enteropathogenic Escherichia coli, lysozyme, and alpha-1-antichymotrypsin on macrophages of genitourinary malacoplakia

Seven cases of genito-urinary malacoplakia were analyzed histologically, ultrastructurally and immunohistochemically in a comparison with two cases of xanthogranulomatous pyelonephritis. Immunohistochemically, von Hansemann cells and Michaelis-Guttmann bodies, both hallmarks for the diagnosis of malacoplakia, showed a common antigenicity for enteropathogenic Escherichia coli as cytoplasmic granules of varying sizes. These microscopic manifestations corresponded ultrastructurally to a series of phagolysosomal degradations of coliform bacilli. Serogroups against E. coli OK antigens, which were positive for malacoplakic cells, were not confined to a particular group. Macrophages of xanthogranulomatous pyelonephritis did not show the E. coli antigenicity. Antigenicity of lysozyme and alpha-1-antichymotrypsin on the von Hansemann cells was equivocal, but these enzymes were strongly positive on macrophages of xanthogranulomatous pyelonephritis. The macrophages of both malacoplakia and xanthogranulomatous pyelonephritis were positive for antihuman macrophage antibody. These results indicate that malacoplakia depends mainly on infection by a non-specific strain of enteropathogenic E. coli and may arise from defective digestive enzyme activity of infiltrating macrophages. Immunohistochemical analysis using antisera against E. coli OK antigens, lysozyme and alpha-1-antichymotrypsin was useful in identifying the prediagnostic stage of malacoplakia and in differentiating the lesion from xanthogranulomatous pyelonephritis.

Immunopathological mechanisms of human T cell lymphotropic virus type 1 (HTLV-I) uveitis. Detection of HTLV-I-infected T cells in the eye and their constitutive cytokine production

The immunopathology of human T cell lymphotropic virus type 1 (HTLV-I) uveitis was addressed by using T cell clones (TCC) established from the intraocular fluid of patients with HTLV-I uveitis. Proviral DNA of HTLV-I was identified in 55 out of 94 (59%) or 13 out of 36 (36%) TCC from the ocular fluid or the peripheral blood of these patients, respectively. Most of HTLV-I-infected TCC had a CD3+ CD4+ CD8- phenotype. HTLV-I infection on TCC was confirmed by analysis of the viral mRNA, nucleotide sequence, virus-associated proteins, and virus particles. HTLV-I-infected TCC, but not HTLV-I negative TCC, constitutively produced high amounts of IL-6 (1,336 +/- 1,050 pg/ml) and TNF-alpha (289 +/- 237 pg/ml) in the absence of any stimuli. HTLV-I-infected TCC from the ocular lesion also constitutively produced high amounts of IL-1 alpha (12,699 pg/ml), IL-2 (61 pg/ml), IL-3 (428 pg/ml), IL-8 (1,268 pg/ml), IL-10 (28 pg/ml), IFN-gamma (5,095 pg/ml), and GM-CSF (2,886 pg/ml). Hydrocortisone, a drug effective in vivo for the treatment of HTLV-I uveitis, severely depressed cytokine production in vitro in most cases. In summary, the results demonstrated direct evidence of HTLV-I infection of the eye and suggest that cytokines produced by HTLV-I-infected T cells are responsible for the intraocular inflammation in patients with HTLV-I uveitis.

CT finding of transient focal increased attenuation of the liver adjacent to the gallbladder in acute cholecystitis

OBJECTIVE

The purpose of this article is to report the finding of transient focal increased attenuation of the liver adjacent to the gallbladder on enhanced CT scans in patients with acute cholecystitis. This finding should not be confused with primary liver abnormalities.

MATERIALS AND METHODS

Five patients with acute cholecystitis were studied. Because a thickened gallbladder wall was seen on sonography, all patients were examined preoperatively with incremental dynamic helical CT to exclude carcinoma of the gallbladder. CT findings were compared with results of sonography for five patients, MR imaging for two patients, and surgery for five patients.

RESULTS

Transient focal increased attenuation of the liver adjacent to the gallbladder was seen in the early phase of incremental dynamic CT in five patients and extended into the medial segment anterior to the porta hepatis. The areas showing increased attenuation adjacent to the gallbladder had a curvilinear shape around the gallbladder. No hepatic masses were seen on sonograms, on MR images, or at surgery.

CONCLUSION

Transient focal increased attenuation of the liver may occur on CT scans in patients with acute cholecystitis. The increased attenuation associated with acute cholecystitis has a typical location and pattern. This finding is probably attributable to hepatic arterial hyperemia and to early venous drainage caused by the adjacent inflamed gallbladder. This finding should be differentiated from hypervascular hepatic tumors.

An experimental study of gastric mucosal blood flow in endotoxemia of the rat, with special reference to the vagus nerve and EDRF

Gastric mucosal lesions are an important complication in endotoxemia. In order to define the role played by the vagus nerve and endothelial-derived relaxing factor (EDRF) in gastric mucosal blood flow, an investigation was carried out on four groups of rats: a control group; a group given lipopolysaccharide (LPS, 5 mg/kg); a group given gossypol-acetic acid (gossypol), which has an injurious effect on the vascular endothelial cell; and a group given L-NG-monomethyl arginine (LNMMA). Following the administration of acetylcholine and papaverine hydrochloride (via the splenic artery) and vagus nerve stimulation in all four groups of rats, the effects of vagus nerve stimulation and EDRF on the gastric mucosal blood flow were determined with a laser Doppler rheometer. In the LPS group, the gastric mucosal blood flow was decreased after acetylcholine administration and vagus nerve stimulation. This was also the case in the gossypol group. These findings suggest that inhibition of EDRF release may be responsible for the reduced gastric mucosal blood flow observed in endotoxemia.

Characterization of CD4+ T helper cells in patients with Kawasaki disease (KD): preferential production of tumour necrosis factor-alpha (TNF-alpha) by V beta 2- or V beta 8- CD4+ T helper cells

KD is an acute febrile illness in children characterized by coronary arteritis accompanied by aneurysm and thrombotic occlusion. The etiology of KD is unknown. It has been recently reported that KD is associated with the selective expansion of V beta 2+ and V beta 8.1+ T cells in peripheral blood lymphocytes (PBL), by studying the T cell receptor (TCR) repertoire of in vitro activated T cells. KD may therefore be caused by a superantigen [1-3]. To understand better the immunopathology of KD, we investigated TCR V beta 2 and V beta 8.1 expression on both the T cells of freshly isolated PBL and T cell clones (TCC) from patients with KD. Cytokine production by TCC was also studied. Blood samples were obtained from patients with acute (n = 20) and convalescent (n = 20) KD, age-matched children with non-infectious diseases (n = 18), and healthy adults (n = 20). Among these four groups, there were no significant differences in the percentages of either V beta 2+ or V beta 8.1+ T cells of freshly isolated PBL. The same was true for the CD4+ or CD8+ T cell subsets. One hundred and five TCC (98 CD3+ CD4+ CD8- and seven CD3+ CD4- CD8+) established from the affected skin, lymph node or PBL of six patients with KD were also negative for either V beta 2 or V beta 8.1 TCR. Sixty-eight of 105 TCC (65%) produced detectable levels (> 5 pg/ml) of TNF-alpha (6-1016 pg/ml), in the absence of any stimuli. In contrast, only 11 (10%) of 105 TCC or 7 (7%) of 97 TCC produced detectable levels of IL-2 or IL-6, respectively, in the absence of any stimuli. Stimulation with phytohaemagglutinin (PHA) and phorbol myristate acetate (PMA) induced most TCC to produce higher amounts of TNF-alpha, IL-2 and IL-6. These results suggest that CD4+ T helper cells expressing TCR-beta other than V beta 2 or V beta 8 receptor, primarily through TNF-alpha production, are involved in the immunopathology of KD.

Changes in the mononuclear cell subpopulations of rat cardiac transplant recipients administered FK506 for the treatment of ongoing rejection

The inhibitory effect of ongoing rejection and the changes that occurred in mononuclear cell subpopulations were compared between four groups of rats treated with FK506 or steroids. Group 1 was given no immunosuppressive drugs, group 2 was given FK506 from the day of grafting, group 3 was commenced on FK506 on the 4th day after grafting, and group 4 was commenced on methylprednisolone (MP) on the 4th day after grafting. The graft survival times in groups 2 and 3 were significantly longer than those in groups 1 and 4, and there were fewer CD3+ and CD4+ T lymphocytes in the peripheral blood in the groups treated with immunosuppressive drugs than in group 1. In group 4, the levels in both the peripheral blood and thymus were significantly lower than those in the groups treated with FK506 despite the fact that graft rejection occurred soon after the discontinuation of steroid administration. Moreover, the levels of interleukin-2 receptors and macrophages in groups 2, 3, and 4 were significantly lower than that in group 1 postoperatively; however, the number of macrophages in groups 2 and 3 was significantly lower than that in group 4 on the 10th day after transplantation. The findings of this study demonstrated that FK506, even if administered after rejection has begun, might inhibit the subsequent extensive allograft rejection more specifically and effectively than steroids, and that the measurement of a marker for macrophages in the peripheral blood could be useful for the detection of rejection following allograft transplantation in rats.

[Optimal concentration of contrast medium in helical CT of the thorax]

In 99 examinations of 89 patients, we took CT images of the chest after administering one of three concentrations of contrast medium (iohexol 140 mgI/ml, 240 mgI/ml, 300 mgI/ml) to determine the optimal iodo-concentration for intravenous contrast enhancement in spiral CT. Attenuation values of the superior vena cava, ascending aorta, descending aorta, and pulmonary artery were measured to evaluate the degree of contrast enhancement. Five radiologists judged the image quality by scoring factors such as vascular opacification, delineation of the lung and chest wall, detectability of calcification, lymphadenopathy and pulmonary nodules, and the presence of artifacts. The relationships between the iodo-concentration and the scores were analyzed statistically. The higher the iodo-concentration of the contrast medium administered, the stronger the vascular structures were opacified. There was also a concurrent improvement in the detection of lymphadenopathy. However, artifacts appeared on the administration route as a result of the high-concentration contrast medium, and the image quality was degraded. Among the three groups, iohexol 240 mgI/ml exhibited the best performance, namely, good image quality, so that a high degree of contrast enhancement of the vasculature was obtained with few artifacts due to the contrast medium. However, we believe that iohexol 140 mgI/ml presents no significant problems in routine studies.

Distribution of HLA antigens and haplotypes in the Buryat population of Siberia

Polymorphisms of HLA-A, B, C, DR, and DQ antigens were investigated in a Mongoloid population named Buryat living in Siberia. HLA gene and haplotype frequencies were calculated from the population data obtained from 141 unrelated healthy Buryat adults. Gene frequencies of class I antigens A2, A24, A1, B61, Cw10, and Cw6 were estimated to be more than 10%. For class II, DR4, DR7, DR13, DQ7, and DQ1 antigens were predominant. A phylogenetic tree was constructed based on HLA gene frequencies, and the Buryat population was clustered with the Mongoloid groups in Northeast Asia. In the analysis of HLA-A, C, B, DR, and DQ five-locus haplotype frequencies, seven kinds of haplotypes were calculated to occur at frequencies of more than 2%. Five of the seven common haplotypes have also been described in the other human populations thus far. Some of the haplotypes have been described in European populations, while the others were shared with Northeast Asian Mongoloids as well as Amerindians. Similar situation was also found in the analysis of class I (HLA-A, C, B) three locus haplotypes. These observations suggest the unique genetic background of this Buryat population.

Qualitative and quantitative evaluation of renal parenchymal damage by 99mTc-DMSA planar and SPECT scintigraphy

The initial 99mTc-DMSA studies carried out over a four year period in 229 patients with various heterogenic causes of lower urinary tract abnormalities were reviewed. Anatomical damage to the renal parenchyma was graded by means of planar and SPECT studies into a six group classification proposed by Monsour et al.: grade 0 (normal), I (equivocal), II (single defect), III (more than 2 defects), IV (contracted or small) and V (no visualization). Parenchymal uptake of 99mTc-DMSA was quantitated from planar images at 2 hours postinjection by a computer assisted gamma camera method. SPECT studies could enhance the pick-up rate for parenchymal uptake defects by a factor of 1.5 in comparison with planar imaging. The incidence of anatomical damage to the renal parenchyma increased with a high radiological grade for VUR, and renal uptake per injection dose of 99mTc-DMSA by the individual kidney significantly decreased in grades III and IV of the anatomical classification. These data revealed that 99mTc-DMSA planar is still useful for evaluating gross structural damage and for quantitative evaluation of the kidney with computer assistance. SPECT scintigraphy is more effective in disclosing anatomical damage to the renal parenchyma than planar, although it needs further discussion as to whether SPECT may increase sensitivity with minimal or no adverse affect on specificity.

[Relationship of dietary intake of sodium, potassium, calcium and magnesium to blood pressure]

Dietary intake of sodium (Na), potassium (K), calcium (Ca) and magnesium (Mg) from measured food intake, and urinary Na and K excretions estimated by analyzing the second voided morning urine were analyzed for correlations to each other and to blood pressure in 57 males and 90 females (average age of 53 years). Significant positive correlations were found between systolic blood pressure and urinary Na/K ratio, dietary Ca/Mg ratio and body mass index after adjustment for age. Diastolic blood pressure was also positively correlated to these variables. By multiple regression analysis, the coefficients for age and urinary Na/K and dietary Ca/Mg ratios were all statistically significantly associated with systolic and diastolic blood pressure. Dietary Ca/Mg ratio was negatively correlated with rice, beans and fish intake, and urinary K excretion positively correlated with fish and green vegetable intakes by the same analysis. These data suggest that the dietary Ca/Mg ratio--but not magnesium singly--as well as aging and urinary Na/K ratio were among important factors related to blood pressure.

Immunochemical detection of urinary 5-methyl-2'-deoxycytidine as a potential biologic marker for leukemia

A monoclonal antibody against 5-methylcytidine was prepared and characterized. This antibody, termed AMC, was reactive with compounds that had 5-methylcytosine structure (i.e. 5-methyl-2'-deoxycytidine, 5-methylcytidine and 5-methylcytosine). AMC had the highest reactivity to 5-methyl-2'-deoxycytidine among reactive compounds and had no or very slight cross-reactivity to cytidine-related compounds and any other compounds. Analysis of immunoreactive materials in urine revealed that 5-methyl-2'-deoxycytidine rather than 5-methylcytidine was, contrary to our expectation, the major component. Then the inhibition ELISA system using AMC was established and urinary levels of 5-methyl-2'-deoxycytidine in healthy individuals and cancer patients were determined. The mean excretion levels of healthy individuals was 0.90 +/- 0.43 nmol/mumol creatinine and the cut-off value was set at the mean + 2 S.D. of healthy individuals (1.76 nmol/mumol creatinine). Among various types of cancer tested, elevated levels of 5-methyl-2'-deoxycytidine were detected in leukemia patients. From these results, urinary 5-methyl-2'-deoxycytidine might be applicable as a biologic marker for leukemia.

Protective protein as an endogenous endothelin degradation enzyme in human tissues

An enzyme hydrolyzing the carboxyl terminus of endothelin-1 was detected in control human tissues but was deficient in tissues from a patient with galactosialidosis, a metabolic disease caused by the protective protein gene mutation. It was proportional to the amount of immunologically estimated mature protective protein. An antibody against the lysosomal protective protein/beta-galactosidase complex precipitated the enzyme activity almost completely. Transfection of the human cDNA for protective protein resulted in high expression of the enzyme activity in transformed fibroblasts from a galactosialidosis patient. These results indicated that the mature protective protein is a major soluble endogenous endothelin degradation enzyme in human tissues.

Effects of delapril on stroke, kidney dysfunction and cardiac hypertrophy in stroke-prone spontaneously hypertensive rats

This study was performed to investigate the beneficial effects of prolonged treatment with an angiotensin converting enzyme (ACE) inhibitor, delapril, on the appearance of symptoms of hypertensive cardiovascular disease in stroke-prone spontaneously hypertensive rats (SHRSP). Cardiovascular disease symptoms: stroke, kidney dysfunction and cardiac hypertrophy, were evaluated by monitoring the incidence of stroke signs, urinary excretion of protein and the heart weight, respectively. The SHRSP that were kept under salt-loaded conditions (1% NaCl drinking solution) from six weeks of age developed severe hypertension, showed an increased incidence of stroke signs and increased urinary excretion of protein. Long-term treatment with delapril (10mg/kg/day, p.o. for four weeks) decreased the blood pressure and completely inhibited the incidence of stroke signs and the increase in urinary excretion of protein. In SHRSP that were kept under normal conditions (without 1% NaCl drinking solution), long term treatment with delapril at the same dose decreased the heart weight and, after five weeks of treatment, left ventricular weight was decreased significantly and the wall/lumen ratio of small coronary arterioles and the thickness of the left ventricular wall were decreased slightly. These results indicate that delapril can prevent the development of symptoms of hypertensive cardiovascular diseases: stroke, kidney dysfunction and cardiac hypertrophy, with antihypertensive activity in SHRSP.

Evaluation of serum tumor markers in patients with advanced or recurrent breast cancer

Serum CA15-3, CEA, and BCA225 concentrations were determined in 98 patients with advanced or recurrent breast cancer in an attempt to correlate elevation with clinical status. The rate of serum positivity was 68.4% (67/98), 55.1% (54/98), and 43.9% (43/98) for CA15-3, CEA, and BCA225, respectively. After a 4 weeks-interval, a 20% change of tumor marker concentration from the preceding assay correlated significantly with clinical findings. Significant elevation was predictive of new recurrence or tumor regrowth after complete remission, especially in patients with bone metastasis. The 20% change in concentration at 4 weeks was also useful in patients with tumor marker concentrations persistently beneath the cut-off level for positive. Serological evaluation of tumor markers in patients with advanced or recurrent breast cancer should seek to document 20% changes over a 4 week interval.

Newly discovered familial juvenile gouty nephropathy in a Japanese family

Our attention was initially called to 2 young Japanese sisters with gout and renal insufficiency, which led to an investigation of members of their family with similar conditions. One sister, a 26-year-old woman who had suffered from polyuria since infancy, suffered from gout and renal insufficiency. Her younger sister also had a history of polyuria, hyperuricemia, and moderately reduced renal function. Their urinary uric acid levels were reduced but purine enzyme activities in the erythrocytes were normal. A renal biopsy specimen from the younger sister showed severe interstitial fibrosis with tubular atrophy. An investigation of the family revealed an autosomal dominant transmission pattern. We believe these are new familial cases of juvenile gouty nephropathy found in a Japanese family.

Anti-neutrophil antibody attenuates the severity of acute lung injury in rats with experimental acute pancreatitis

OBJECTIVE

To examine the role of activated neutrophils in microvascular injury after severe acute pancreatitis. We used the polyclonal anti-rat neutrophil antibody (PoAb) to deplete peripheral neutrophil counts and the anti-rat monoclonal antibody (MoAb) CD18 to block neutrophil adherence functions.

DESIGN

Prospective, controlled trial.

SETTING

Laboratory.

PARTICIPANTS

Anesthetized male Wistar breeder rats, in which necrotizing pancreatitis was induced by injecting necrotizing agents into the pancreatic duct.

INTERVENTIONS

Treatment groups received an infusion of PoAb, 8 mL/kg, before induction of pancreatitis or MoAb CD18, 2 mg/kg, after induction of pancreatitis. Control animals received 2 mL of rabbit serum or 1 mL of saline solution.

MAIN OUTCOME MEASURES

Survival rate, white blood cell count, levels of serum amylase and lipase, myeloperoxidase activity in the lung, lipid peroxide levels in the pancreas, and results of histological studies.

RESULTS

The survival rate of rats treated either with PoAb before or MoAb CD18 after induction of sepsis improved significantly (P < .01). Histologically and according to the levels of neutrophil myeloperoxidase in their lungs, rats treated with the antibodies 24 hours after inducing pancreatitis improved significantly (P < .05). Moreover, the serum lipase concentrations and lipid peroxide levels in the pancreas of these rats decreased significantly (P < .05).

CONCLUSIONS

Both the depletion of peripheral neutrophils by PoAb and blocking of neutrophil adherence functions by MoAb CD18 may help to prevent acute lung injury caused by severe acute pancreatitis in this model.

A limited sampling model for estimating pharmacokinetics of CPT-11 and its metabolite SN-38

The objective of this study was to develop a limited sampling model (LSM) to estimate the area under the curve (AUC) of 7-ethyl-10-[4-(1-piperidino)-1-piperidino]carbonyloxycamptothecin (CPT-11) and that of 7-ethyl-10-hydroxycamptothecin (SN-38) as predictive pharmacokinetic variables for leukopenia and episodes of diarrhea induced by CPT-11 administration. The model was developed with a training set consisting of pharmacokinetic studies in 36 patients who received a 90-min i.v. infusion of CPT-11 at a dose of 100 mg/m2. A multiple regression analysis of CPT-11 or SN-38 concentrations observed at each time point in the training set was used to predict the AUC of CPT-11 or SN-38. The final sampling models using only two time points were: AUCCPT-11 = 3.7891*C2.5 + 14.0479*C13.5 + 1.5463 AUCSN-38 = 0.5319*C2.5 + 19.1468*C13.5 + 72.7349 where C2.5 and C13.5 are the plasma concentration of CPT-11 (micrograms/ml) or SN-38 (ng/ml) at 2.5 and 13.5 h after the initiation of CPT-11 infusion, respectively. The models were validated prospectively on a separate test data set of 12 patients receiving the same dose of CPT-11 investigated in a previous study. Validation of the final LSM on the test data set gave values of root mean square error (RMSE) of 12.72% and 5.97% for the AUC of CPT-11 and that of SN-38, respectively. The model can be used to monitor the AUCs of both CPT-11 and SN-38 for the early prediction of toxicities and to establish a pharmacokinetically based dose modification strategy for safe administration of CPT-11.

Pharmacological correlation between total drug concentration and lactones of CPT-11 and SN-38 in patients treated with CPT-11

The pharmacokinetics of 7-ethyl-10-[4-(1-piperidino)-1-piperidino]carbonyloxycamptothecin (CPT-11) and its active metabolite, 7-ethyl-10-hydroxycamptothecin (SN-38), were examined to establish the pharmacokinetic variability of the active lactones of CPT-11 and SN-38 in comparison with that of the total (lactone and carboxylates) plasma CPT-11 and SN-38. Twelve patients with malignancies were entered in the study. All received 100 mg/m2 of CPT-11 by intravenous drip infusion over 90 min. Blood was sampled at 10 time points in heparin-containing syringes. Analysis by high-performance liquid chromatography showed that the ratio of CPT-11 lactone to total CPT-11 concentration was highest (66%) just after the end of infusion and gradually decreased to 30% at 24 h. Almost 70% of SN-38 lactone was detected after the end of infusion and this decreased to 50% within 24 h. The standard errors of percent lactone of CPT-11 of SN-38 to total drug concentration at each sampling point were less than 12%. The area under the concentration-time curve (AUC) of total CPT-11 and that of total SN-38 were significantly correlated with the AUCs of the lactone CPT-11 and those of lactone SN-38, respectively. We conclude that, for practical purposes, monitoring of total CPT-11 and SN-38 has essentially the same clinical significance as monitoring of lactone CPT-11 and SN-38.