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.

Treatment of advanced hormone-refractory prostate carcinoma with a combination of etoposide, pirarubicin and cisplatin

A total of 20 patients with hormone-refractory prostate carcinoma entered a pilot study of combination chemotherapy based on the EAP (etoposide, Adriamycin and cisplatin) regimen, in which Adriamycin was replaced by pirarubicin, a less cardiotoxic derivative of Adriamycin. The response was assessed by criteria modified from those of the National Prostatic Cancer Project: prostate-specific antigen was employed instead of acid phosphatase. Of 18 evaluable patients, 6 achieved a partial response, 5 had stable disease, and in 7 the disease had progressed during therapy; thus, the overall response rate was 33.3% [95% confidence interval (CI) 11.5-55.1%]. Significant pain alleviation and performance status improvement were obtained in 5 of 12 patients (41.7%; CI 13.8-69.6%) and 3 of 13 patients (23.1%; CI 0.2-46.0%), respectively. Although myelosuppression was moderate to severe, no chemotherapy-related deaths or bacteriologically documented sepsis occurred; nor was there any clinical cardiotoxicity. All the responding patients received maintenance chemotherapy with etoposide thereafter. At present, the median duration of response is 33 weeks (range: 23-91 weeks) and the median survival period for all patients is 42 weeks (range: 27(+)-136 weeks), with 12 deaths. In spite of the small number of patients treated, these results suggest that this chemotherapy regimen is active in advanced hormone-refractory prostate carcinoma.

Heparin effects on superoxide production by neutrophils

Heparin is widely used in the treatment of various diseases, but the mechanisms of its biologic actions remain largely obscure. Recently, oxygen radicals, which are produced in a variety of conditions and cause tissue damage, have been implicated in the pathophysiology of various diseases. To investigate the relationship between heparin and oxygen radical production by neutrophils, we compared the effects of standard heparin (heparin sodium), which has been widely used, and a recently developed low molecular weight heparin (LMWH) which has potent anti-Xa activity, on neutrophil oxygen radical production in vitro. Standard heparin increased neutrophil oxygen radical production slightly at the low concentrations used clinically but reduced it at high concentrations, so that the effect of heparin on neutrophil oxygen radical production was biphasic. The effects of LMWH on neutrophil oxygen radical production were slight at both low and high concentrations. In disseminated intravascular coagulation (DIC) locally activated neutrophils produce oxygen radicals and have toxic effects in vivo. Thus we concluded that LMWH should be indicated for the treatment of DIC.

Developmental and Hormonal Regulation of Rice [alpha]-Amylase(RAmy1A)-gusA Fusion Genes in Transgenic Rice Seeds

Transgenic seeds of rice (Oryza sativa L.) were used to investigate temporal, spatial, and hormonal regulation of a rice [alpha]-amylase gene, RAmy1A. Two overlapping segments of the RAmy1A promoter were fused to the coding region of the bacterial reporter gene, gusA. The resulting promoter-gusA fusions, pE4/GUS (-232 to +31) and pH4/GUS (-748 to +31), were used separately to transform rice protoplasts. [beta]-Glucuronidase (GUS) activity was detected in germinated transgenic seeds, although the two constructs showed no significant difference in timing or location of GUS expression. Both constructs first expressed GUS in the scutellar epithelium and then in the aleurone layer. Aleurone expression of GUS activity was strongly induced when embryoless half-seeds were treated with gibberellic acid. GUS expression in the aleurone layer was also suppressed by abscisic acid. These results indicate that the 5[prime] regulatory region from -232 to +31 is sufficient for temporal, spatial, and hormonal regulation of RAmy1A gene expression.

Polyclonal use of T-cell receptor alpha for human T-cell lymphotropic virus type 1-infected T cells

PURPOSE

To understand better the immunopathology of HTLV-I uveitis by investigating the clonality of HTLV-I-infected T-cell clones.

METHODS

Eleven T-cell clones were established from the aqueous humor (six clones) and the peripheral blood (five clones) of a patient with HTLV-I uveitis, and the clonality of the HTLV-I-infected T cells was investigated by sequencing the T-cell receptor (TCR) alpha gene after the amplification of TCR alpha cDNA using an adaptor-ligation method and reverse transcriptase-polymerase chain reaction (RT-PCR).

RESULTS

TCR alpha use was different for each of 11 T-cell clones, encompassing eight different HTLV-I-infected T-cell clones (four from the aqueous humor and four from peripheral blood) and three HTLV-I-negative T-cell clones.

CONCLUSIONS

This study demonstrated polyclonal use of TCR alpha for HTLV-I-infected T cells in the ocular lesion and the peripheral blood. Results suggested that these T cells are not precursors of the leukemic cells associated with malignant transformation. Instead, they might be randomly infected with HTLV-I in the process of HTLV-I uveitis.

Phosphomonoesters in the guinea-pig taenia caeci: pH-dependency of the phosphomonoester peaks in 31P-NMR

In the smooth muscle of guinea-pig taenia caeci, unlike cardiac and skeletal muscles, two prominent peaks are constantly observed in the phosphomonoester (PME) region (at 6.8 and 6.3 ppm) of 31P-NMR spectra. Tissue extracts, whose pH were adjusted to the intracellular pH of 7.1, also showed such peaks. According to the pH-dependency of the chemical shifts of known PMEs, these peaks were identified as phosphorylethanolamine (PEt) and phosphorylcholine (PCh), the intermediary metabolites of membrane phospholipid turnover. In normal solution, the intracellular pH (pH(i)) which was estimated from the chemical shifts of PMEs (PEt 7.07; PCh 7.17) agreed with that from P(i) (7.10). When preparations were exposed to hypoxia and high-Mg2+ conditions, a reasonable correlation was found between estimations of pH(i) from the PME and P(i) peaks. The chemical shifts of these PME peaks may be used for estimation of pH(i), at least, when there is a need to know relative changes of pH(i), as a complementary purpose, and also whenever the P(i) peak is not clearly observed.

Rapid superoxide production by endothelial cells and their injury upon reperfusion

Cultured human umbilical vein endothelial cells (EC) were exposed to hypoxia for various time periods followed by reoxygenation, and production of both O2- and H2O2 by EC was measured using the cytochrome c and scopoletin methods, respectively. Production of significant amounts of O2- was observed as early as 1 min after reoxygenation, reached maximum at 3 min and seemed to decline thereafter. Production of H2O2 was observed slightly later than that of O2-. Endothelial cell injury during hypoxia/reoxygenation was determined by both the trypan blue dye exclusion and chromium release methods. Significant increase of EC injury was detected after reoxygenation by both methods. This injury was significantly inhibited by allopurinol but not by superoxide dismutase or catalase. These results indicate that the production of reactive oxygen metabolites by EC and EC injury occur very rapidly after reoxygenation, which has not been reported, and these should be taken in consideration for the understanding and treatment of the clinical reperfusion injury.

Circulating activated T lymphocyte subsets in patients with silent thyroiditis

In order to investigate the immunological aspects of silent thyroiditis, T lymphocyte subsets were analyzed by two-color flow cytometry in 10 patients with silent thyroiditis in the thyrotoxic phase, 12 patients with silent thyroiditis in the recovery phase, and 11 healthy volunteers as a control. The percentages of CD3+, CD4+, and CD8+ cells were similar in all three groups. In contrast, activated matured T (HLA-DR+CD3+), activated helper/inducer T (HLA-DR+CD4+) and activated suppressor/cytotoxic T (HLA-DR+CD8+) cells were more numerous in both the thyrotoxic and the recovery phases of patients with silent thyroiditis when compared with healthy controls. In a serial study of 6 patients with silent thyroiditis, the percentage of activated helper/inducer T (HLA-DR+CD4+) cells was higher in the thyrotoxic phase than in the recovery phase. These data indicate that the activation of T cells, especially of helper/inducer T cells, might be important for the induction of silent thyroiditis.

[Intra-ocular pressure changes during laparoscopic cholecystectomy]

Intra-ocular pressure (IOP) was measured during laparoscopic cholecystectomy (n = 20) under continuous epidural block and nitrous oxide-oxygen anesthesia. There was a slight but significant increase in IOP and peak airway pressure when the abdominal CO2 insuffration was started, and the IOP recovered to the preoperative level after the postural change to the head-up position. It was not associated with any significant change in mean arterial pressure and end-tidal CO2. In one ocular hypertension case undergoing laparoscopic chorecystectomy and appendectomy, however, there was profound increase in IOP during abdominal CO2 insuffration with head down position. We speculate that it was due to the effect of increased CVP with abdominal CO2 insuffration and postural change on the IOP. Thus the laparoscopic operation with head-down position should be avoided in patients with ocular hypertension.

Synthesis and human immunodeficiency virus (HIV)-1 protease inhibitory activity of tripeptide analogues containing a dioxoethylene moiety

Tripeptide analogues 2 and 3 containing a dioxoethylene moiety were designed based on the characteristic structure of the naturally occurring human immunodeficiency virus (HIV)-1 protease inhibitors RPI-856 A, B, C and D (1). The compounds (2, 3) prepared showed high inhibitory activity, comparable to that of RPI-856 A, against HIV-1 protease in vitro.

Effect of filler content on bonding efficacy of 4-META MMA/TBB bonding agent

The effect of adding micro filler to 4-META MMA/TBB dentin bonding agent was examined by measuring the wall-to-wall polymerization contraction gap of a commercial light-cured resin composite in a cylindrical dentin cavity and the tensile bond strength of the flat dentin surface. Gap formation was not completely prevented by using a filled dentin bonding agent although the tensile bond strength was significantly greater than that obtained using the unfilled dentin bonding agent. These results indicate that the addition of micro filler to the dentin bonding agent does not produce complete adaptation of the resin composite to the dentin cavity wall.

Antiarrhythmic effects of eicosapentaenoic acid during myocardial infarction--enhanced cardiac microsomal (Ca(2+)-Mg2+)-ATPase activity

The effects of dietary supplementation with eicosapentaenoic acid (EPA) on ventricular arrhythmias during myocardial infarction were examined in a canine model. EPA was incorporated into cellular membranes after ingestion of EPA-ester (100 mg/kg body weight/day) for 8 weeks. The ratio of EPA to arachidonic acid (AA) in platelet cell membranes and myocardial microsomes was significantly increased (7% to 37% in platelet cell membranes; p < 0.01, 3% to 12% in non-infarcted cardiac microsomes; p < 0.01, and from 2% to 8% in infarcted cardiac microsomes; p < 0.01). Dietary supplementation with EPA significantly reduced the incidence and severity of arrhythmias during coronary artery occlusion. Immediately after coronary artery occlusion, all of the animals in the control group that were given a toxic dose of digitalis developed ventricular tachycardia (VT) or ventricular fibrillation (Vf), whereas none of the animals in the EPA-supplement group developed VT or Vf within 15 min after administration of digitalis. Regardless of the presence of an infarcted area, the specific activity of the Ca(2+)-pump enzyme ((Ca(2+)-Mg2+)-ATPase) within the myocardial microsomal fraction of the EPA-supplemented group was significantly higher than in that of the control group (Vmax: 140.5 +/- 19.1 vs 94.8 +/- 28.9 nmol/mg/min in non-infarcted cardiac microsomes, p < 0.01, 130.9 +/- 18.4 vs 90.2 +/- 26.4 nmol/mg/min in infarcted cardiac microsomes, p < 0.01, EPA vs control group, respectively). The specific activities of the Na(+)-pump enzyme ((Na(+)-K+)-ATPase) and NADPH-dependent cytochrome C reductase in infarcted and non-infarcted cardiac microsomes did not differ between these groups. These results indicate that EPA supplementation increases the (Ca(2+)-Mg2+)-ATPase activity within myocardial membranes that is involved in Ca2+ metabolism in myocardial cells by increasing the ratio of EPA to AA within cellular membranes. These cellular alterations are likely to reduce the severity of ventricular arrhythmias by inhibiting the rapid accumulation of intracellular Ca2+ following ischemia.

Urinary prolactin excretion in children with renal disease

The contribution of the kidney to the metabolism of prolactin has not yet been established. In the present study, urinary prolactin concentrations in 30 children with renal disease were measured by a newly devised, highly sensitive, time-resolved immunofluorometric assay. Median prolactin concentrations in the urine of children with renal disease, were 1.86 pmol/L-1 of urine (range: 0.17-546.31 pmol/L-1. By stepwise regression analysis, change in urinary prolactin levels as a function of the urinary beta 2-microglobulin concentrations was detected. These results indicate that prolactin urinary excretion in children with renal disease is dependent on the renal proximal tubular function.

Distribution of lysosomal protective protein in human tissues

We raised two polyclonal antibodies against synthetic oligopeptides comprising amino acid sequences in the human lysosomal protective protein. The first antibody recognized the 54-kDa precursor and the N-terminal sequence of the 32-kDa mature protein subunit, and the second one recognized the precursor and the C-terminal sequence of the 20-kDa subunit. In normal fibroblasts, mature protective protein was detected on immunoblotting with these antibodies. Considerable amounts of mature protective protein also were detected in kidney, lung, liver, and spleen, but not in brain from a patient with Gaucher disease. Neither the precursor nor the mature protective protein was detected in cultured fibroblasts, liver or cerebrum from a galactosialidosis patient with protective protein deficiency.