Purification and properties of glucosyltransferase from Aureobasidium

Purification and properties of glucosyltransferase, which produces panose (Glc alpha 1-->6Glc alpha 1-->4Glc) and isomaltose (Glc alpha 1-->6Glc) from maltose (Glc alpha 1-->4Glc), are reported. The enzyme, from Aureobasidium, was purified to homogeneity by fractionations involving ammonium sulfate and DEAE-Cellulofine, S-Sepharose Fast Flow and Sephadex G-200 chromatography. Molecular mass of the enzyme was estimated to be 395 kDa by gel filtration. The enzyme was identified as a glycoprotein which contains 32% (w/w) carbohydrate. The optimum pH for the enzymatic reaction was 4.5-5.5 and the enzyme was stable over a pH range of 4-6. The optimum reaction temperature for the enzyme was 65 degrees C and the enzyme retained more than 96% activity at 60 degrees C after 15 min. The enzyme produced panose from maltose by means of a high efficiency (45.5%) glucosyl-transfer reaction. The enzyme was inhibited by metal ions, such as those of mercury, silver and aluminum, and also by organic inhibitors, especially nitrilotriacetic acid.

[Description of arterial grafts from the aspect of preoperative angiography]

Bilateral internal thoracic arteries (ITA) and right gastroepiploic artery (RGEA) have come into more frequent use of late in coronary revascularization. Angiography of these arterial grafts, however, is performed only postoperatively in almost all patients. There have, so far, been no reports giving a preoperative angiographic description of each arterial graft. In this paper, we describe a study in which we performed preoperative angiography of ITA and RGEA and made a comparison of various grafts, which yielded interesting findings. Twenty-four patients (68 arterial grafts) who were judged to need surgery were performed preoperative angiography of the grafts. The diameter of ITA was measured at three points--the proximal part (Prox), center (Cent) and bifurcation of the artery near the rectus abdominal muscle (Bif). The diameter of RGEA was measured at two points--the proximal part and at 1/2 of the greater curvature of the stomach (Mid). The graft diameter of RGEA was 2.78 mm and significantly the largest, followed by RITA (2.59 mm) and LITA (2.08 mm), when the diameters of the proximal parts of the grafts were compared. Comparison of the diameters of RGEA-Mid and ITA-Bif, which were expected to be the anastomosis sites, also showed that RGEA was significantly the largest, and that the right ITA tended to be larger than the left ITA. Of the 24 patients, 68 arterial grafts, on which angiography was performed, 2 patients were found to have arterial occlusion and 1 to have arteriostenosis.(ABSTRACT TRUNCATED AT 250 WORDS)

A non-radioisotopic method for tracing neutrophils in vivo using 5'-bromo-2'-deoxyuridine

Polymorphonuclear leukocytes (PMN) labeled in vivo with 5'-bromo-2'-deoxyuridine (BrdU) in donor animals were transferred to recipients to determine the rate of clearance of labeled PMN from the circulation, their margination within the vascular space, and migration into Streptococcus pneumoniae-induced inflammatory sites. The donor animals received intravenous infusions at 25 mg/kg/day of BrdU for 7 days when cytospins of leukocyte-rich plasma (LRP) showed that 80 +/- 2.3% PMN were labeled. The BrdU labeled cells were then transfused to serum-compatible recipients as either whole blood, leukocyte-rich plasma, or PMN purified from an equal volume of whole blood. Twenty-four hours after transfer, the distribution of BrdU-labeled PMN in the lung, liver, spleen, bone marrow, and gut was determined morphometrically and by Southern blot analysis of DNA extracted from these organs. BrdU-labeled PMN transfused as either LRP or purified PMN provided no advantage over transfusing whole blood. The half-life of BrdU-labeled PMN in the recipient circulation after transfusing whole blood was 270.4 min (95% confidence intervals, 248.5 to 296.4 min). The majority of the BrdU-labeled DNA was found in the spleen, where DNA analysis showed that the white blood cells underwent programmed cell death by apoptosis. Four hours after infection with S. pneumoniae and 1 h after transfusion of labeled whole blood, BrdU-labeled PMN had migrated into the infected sites. We conclude that transfer of BrdU PMN in whole blood provides a simple, effective method of tracing labeled PMN in vivo.

Regulating factors of liver regeneration after hepatectomy

The factors regulating liver regeneration were studied by measuring changes in the liver volume and serum hepatocyte growth factor (HGF) levels after hepatectomy. Changes in the liver volumes were studied in 68 hepatectomized patients, including (A) hepatoma patients who had chronic hepatitis or liver cirrhosis (n = 44) and (B) metastatic liver cancer patients who had normal liver parenchyma (n = 24). The hepatic volume increased by 13.8% of the remnant hepatic volume in group A and by 49.1% in group B. The examined factors included the percentage of resected liver volume (%RLV) and the results of laboratory tests. Regression analysis showed that in group A, both %RLV (beta = 0.46) and the serum total bilirubin (T-Bil) level (beta = -0.33) correlated significantly with the extent of liver regeneration and that in group B, only %RLV (beta = 0.78) correlated significantly with the regeneration. Serum HGF levels after hepatectomy were studied in 21 hepatectomized patients, including 11 hepatoma patients and 10 patients with some types of metastatic liver cancer. Serum HGF levels increased significantly after surgery in all 21 patients. Regression analysis, however, showed that the change in HGF was related to liver cirrhosis (beta = 0.46) and to the maximal postoperative T-Bil level (beta = 0.51) but not to the extent of liver regeneration after hepatectomy. These results suggest that liver regeneration is regulated primarily by factors relating to the percentage of the resected liver parenchyma and that serum HGF levels do not directly relate to liver regeneration after surgery.

[A case of gastric cancer occurred after coronary artery bypass grafting using the right gastroepiploic artery]

We experienced a rare case of the gastric cancer occurred after the coronary artery bypass grafting (CABG) using the right gastroepiploic artery (RGEA). On April, 1990, a 74-year-old woman underwent CABG using RGEA for angina pectoris due to 99% stenosis of the right coronary artery. Anorexia and vomiting appeared from December 1992. Examination of the stomach by an oral procedure led to a diagnosis of the pyloric stenosis due to the gastric cancer. The coronary arterial lesion was progressive, and 90% stenosis of LAD (#6, #7) was noted. On February 1993, the re-CABG and the gastrectomy were performed simultaneously. The re-CABG using the saphenous vein was performed to #3, and additional CABG using the bilateral internal thoracic artery were performed to #8 and #9. At the same time, the gastrectomy were performed and RGEA was resected to remove the R2 lymph node completely. If the root of RGEA had been exposed completely at the first operation, RGEA could be preserved as the bypass graft.

Tyrosine-specific protein kinase participates in the pathogenesis of acute immune complex alveolitis in rats

Rabbit IgG antibodies against ovalbumin (OA) was injected intravenously into Wistar rats. When the animals were challenged with OA aerosolized by ultrasonic nebulization, acute lung injury occurred as reflected by increased recovery of bronchoalveolar cells, especially polymorphonuclear leukocytes (PMN) in bronchoalveolar lavage fluid (BALF). Lung morphology demonstrated cellular infiltration in the alveolar septa and intra-alveolar hemorrhage. When the rats were administered ST-638, a novel tyrosine kinase inhibitor, intraperitoneally prior to nebulization, the number of PMN in BALF decreased in a dose-dependent manner and superoxide anion (O2-)-producing activity in peripheral leukocytes was significantly suppressed. Furthermore, the reagent inhibited migration of human peripheral blood neutrophils induced by the chemotactic peptide f-met-leu-phe in vitro. These studies strongly indicate that tyrosine kinase plays an important role in immune complex-triggered neutrophil-related lung disorders, and the novel tyrosine kinase inhibitor ST-638 attenuates lung injury by preventing superoxide production and neutrophil migration.

Marked clinical improvement in patients with hepatocellular carcinoma by surgical removal of extended tumor mass in right atrium and pulmonary arteries

Two patients with advanced hepatocellular carcinoma presented severe exertional dyspnea because of extension of a tumor into the right side of the heart. Removable of the tumor thrombus by open-heart surgery ameliorated the symptoms in each case, but their subsequent courses differed considerably. One patient survived for as long as 8 months thanks to successive multi-disciplinary treatments, whereas the other patient died suddenly 1 month after the surgery. The first patient's hepatocellular carcinoma was more differentiated, and the dyspnea was caused by a low cardiac output due to the intracardiac tumor mass, not by pulmonary embolism as in the second patient's case. We conclude that successive multidisciplinary treatments to control the growth of hepatocellular carcinoma is the most important approach and is indispensable for improving the prognosis.

[Clinical evaluation of intracavernous self-injection of vasoactive drugs for impotence: a long-term follow-up observation]

From December 1989 to September 1992, nine patients with impotence were instructed to perform intracavernous self-injection of vasoactive drugs. At first 40 mg of papaverine hydrochloride was used in all patients and the response on erection was evaluated. If the response did not show sufficiently functional erection, a mixture of 40 mg of papaverine hydrochloride and 1 mg of phentolamine mesylate or 20 mg of prostaglandin E1 was reinjected. Eight patients had achieved full erections and vaginal penetrations without noteworthy complications during the follow-up period. Out of eight patients, three patients were able to ejaculate and one patient showed recovery of erection. No major side effects were seen. In conclusion, intracavernous self-injection is a useful modality for impotence.

Prospective and randomized clinical trial for the treatment of hepatocellular carcinoma--a comparison between L-TAE with farmorubicin and L-TAE with adriamycin: preliminary results (second cooperative study). Cooperative Study Group for Liver Cancer Treatment of Japan

A randomized controlled clinical trial was conducted to compare the use of farmorubicin (FARM) and adriamycin (ADR) in Lipiodol transcatheter arterial chemoembolization (L-TAE) as a treatment of hepatocellular carcinoma. In all, 192 hospitals participated, and 415 patients were enrolled in the study during the period from October 1989 through December 1990, and their data were collected. The patients were randomly allocated to group A (FARM) or group B (ADR) by a central telephone registration. Several clinical characteristics were slightly worse in group A than in group B, but there was no statistically significant difference. The actual doses of FARM and ADR were 72 mg/body and 48 mg/body, respectively. Additional treatments, including repeated TAE or surgery, were given to 248 patients. The 1- and 2-year survival rates were 69% and 44% for group A and 74% and 57% for group B, respectively. The difference was marginally significant (P value in the log-rank test, 0.038). When each group of patients was classified into two subgroups, i.e., high-risk and low-risk categories, based on the severity index calculated by the Cox regression model from significant prognostic factors, the ADR subgroup was significantly superior to the FARM subgroup in the low-risk category, but there was no significant difference between the subgroups in the high-risk category. The change in the serum alpha-fetoprotein level, the extent of Lipiodol accumulation in the tumor, and the extent of tumor reduction did not show any significant difference between the groups. At the above-mentioned doses, ADR seemed to have efficacy almost the same as or slightly superior to that of FARM in L-TAE for the treatment of hepatocellular carcinoma.

[Bladder hernia: report of two cases]

Case 1. A 55-year-old male visited our hospital complaining of dysuria and two-staged micturition. Physical examination revealed a fist sized, elastic soft mass in the left inguinal region. Upright drip infusion pyelography (DIP) showed left inguinal hernia of the bladder. Retrograde urethrography showed bladder neck contracture and a diverticulum. Cystoscopy revealed a indentation in the left bladder wall. Urodynamic studies demonstrated organic obstruction in the lower urinary tract. From these findings, diagnosis was made as bladder hernia and bladder neck contracture. Resection of thin portion of the bladder wall and hernia repair, accompanied by prostatectomy, was performed. Case 2. A 37-year-old male visited our hospital with the history of ureteral stone and chronic prostatitis. Upright DIP incidentally revealed the small right inguinal bladder hernia. Because he had no complaint of dysuria and two-staged micturition, he was observed without surgical treatment.

Cytomegalovirus (CMV) antigenaemia for rapid diagnosis and monitoring of CMV-associated disease after bone marrow transplantation

A technique for the rapid detection of cytomegalovirus (CMV) antigen-positive blood leucocytes (CMV antigenaemia) was evaluated in 15 marrow transplant patients as a means of diagnosis and for monitoring CMV-associated disease. CMV antigenaemia was determined by direct immunoperoxidase staining of leucocytes with a peroxidase-labelled monoclonal antibody, HRP-C7, which binds an immediate-early antigen of human CMV. CMV antigenaemia occurred in 7/15 marrow transplant patients (47%) and was initially detected between 4 and 6 weeks after transplantation. CMV-associated diseases developed in 3/15 patients (20%). All patients with CMV-associated disease had a relatively large number of CMV antigen-positive leucocytes, exceeding 10 per 50,000 white blood cells (WBCs). In the remaining 12 patients, CMV antigen-positive leucocytes were less than 10 per 50,000 WBCs or were undetectable. CMV-associated disease did not develop in these patients during the period of monitoring. CMV antigen-positive leucocytes were detected more frequently in patients who developed acute graft-versus-host disease (GVHD) or haemorrhagic cystitis than in those without such complications. CMV antigens were detectable from 1 to 4 weeks before the onset of CMV-associated disease which allowed initiation of ganciclovir treatment at an early stage. The degree of CMV antigenaemia paralleled the clinical symptoms and signs, higher degrees of antigenaemia being associated with more significant disease. Thus, the detection of CMV antigen-positive blood leucocytes is useful for the diagnosis and monitoring of CMV-associated disease following bone marrow transplantation.

Elevated platelet-associated IgG in SLE patients due to anti-platelet autoantibody: differentiation between autoantibodies and immune complexes by ether elution

The level of platelet-associated IgG (PAIgG) is reported to be elevated in patients with systemic lupus erythematosus (SLE). However, the nature of PAIgG is unclear. We have investigated whether the PAIgG of SLE consists of anti-platelet autoantibodies or immune complexes (IC). The PAIgG values measured by flow cytometry were elevated in 11/25 patients with SLE. 3/6 SLE patients with thrombocytopenia had a high level of PAIgG (the mean fluorescence intensity > 10). We used an ether elution technique to determine whether elevated PAIgG consists of anti-platelet antibodies or IC. Preliminary experiments showed that the eluates prepared from platelets sensitized with anti-HPA-4a antibody reacted with normal platelets, while the eluates prepared from platelets sensitized with heat-aggregated IgG or model IC failed to react with normal platelets. These results indicate that the reactivity of eluates can distinguish between platelet-bound antibody and IC. We applied this technique to analysis of the PAIgG of SLE platelets. The eluates from SLE platelets (the mean fluorescence intensity > 10) reacted with normal platelets, indicating that the PAIgG of SLE platelets has the nature of antiplatelet autoantibodies. Furthermore, we investigated the target antigens which bind PAIgGs of SLE, using the direct immunoprecipitation procedure and modified antigen capture ELISA (MACE). Both methods identified GPIIb/IIIa as the target antigens. We conclude that the ether elution technique can distinguish between anti-platelet antibodies and IC, and that the PAIgGs of SLE with a high PAIgG value and thrombocytopenia have the nature of anti-platelet autoantibodies.

Natural antibody against Thomsen-Friedenreich antigen in sera of patients with carcinomas and infectious diseases

The levels of natural antibody against Thomsen-Friedenreich (TF) antigen in sera of patients with various cancers and infectious diseases were examined by an enzyme-linked immunosorbent assay (ELISA) and compared with those of healthy donors. The levels of antibody against TF antigen in sera of patients with adenocarcinomas such as gastric, pancreatic and colorectal cancers were lower than those of patients with hepatoma, pyelonephritis and pneumonia. These findings may reflect the expression of TF-antigen in adenocarcinoma tissues.

[The incidence of atherosclerotic lesions of the carotid artery in people of one community]

Carotid sonography were conducted in people of one community (122 males and 243 females) in 1990 and 1991. The intima-media thickness (IMT) in the main trunk and bifurcation-bulb areas of bilateral carotid arteries were measured in 122 males. IMTs of four areas increased with aging. In all cases, the average IMT of the right main trunk was 0.8 +/- 0.1 mm (mean +/- SD) and those of the remaining three areas were 0.9 +/- 0.2 mm. The IMT of the right bifurcation area in males aged 75 years or older was the thickest; i.e., 1.1 +/- 0.3 mm. Therefore, atherosclerotic lesions (AL) were defined as an IMT of 1.5 mm or more. The incidence of AL increased along with aging both in males and females. In those who were less than 65 years old, the incidence in males was 12.8% (10/78) and that in females was 9.0% (12/134). In those who were 65 years old or older, the incidence in males was 31.8% (14/44) and that in females was 26.9% (29/109). The incidence of AL tended to increase rapidly from 65 years of age in both males and females. Moreover, the incidence of AL in bilateral carotid arteries increased along with aging as well. Since IMT, the incidence of AL and that of AL in bilateral carotid arteries increased with aging, we considered that these parameters could be used as indices of the degree of general atherosclerosis.

[Clinical pharmacology and efficacy of S-1108]

We studied the pharmacokinetics of a new cephem antibiotic, S-1108, in patients with impaired kidney functions. Serum and urinary levels of S-1006 were determined after oral administration of S-1108 at 150 mg to 9 patients with renal dysfunction. In patients with severe renal impairment, high serum levels were maintained over long periods of time. Urinary excretion rates of S-1006 were lower as degrees of kidney failure were severer. S-1108 was administered to treat 27 patients with respiratory tract infections, and its clinical efficacy and safety were evaluated. The clinical efficacies were good in 26 patients, but poor in 1, yielding an efficacy rate of 96.3%. As to adverse reactions; diarrhea was observed in one case. Laboratory tests revealed elevated GOT and GPT in 1, and elevated gamma-GTP in another. These abnormalities, however, were slight and no severe side effects were caused by the drug.

[A case of modified maze operation for atrial fibrillation accompanied by mitral stenosis]

A 45-year-old man suffering from mitral stenosis and atrial fibrillation underwent a mitral commissurotomy and received a modified maze operation. In order to preserve the sinus node artery, we used a new incision line differing from that of Cox and introduced a cryosurgery. After the operation, atrial fibrillation disappeared. The atrial kick was also clearly observed by the echocardiogram. We think that combined operations have advantage both to cure atrial fibrillation and to deal with the mitral valve easily.

Urinary protein C inhibitor binding region in the B beta-chain of human fibrinogen

The urinary protein C inhibitor (PCI) binding region in the B beta-chain of human fibrinogen was examined by ligand blotting, reverse-phase HPLC and amino acid sequencing. The B beta-chain, isolated from reduced and pyridylethylated fibrinogen, was digested with staphylococcal V8 protease to yield eight peptides consisting of 10, 12, 13, 13.5, 14, 16, 17 and 18 kDa bands and the cleaved peptides were ligand-blotted. The 12 kDa band bound to urinary PCI. Moreover, the digested B beta-chain was isolated by reverse-HPLC and the elution peak showing positive binding to urinary PCI was sequenced. The N-terminal amino acid sequence was A V S Q T, which corresponds to Ala106-Thr110 in the B beta-chain. Judging from the M(r) of this peptide (12 kDa), it comprises the region from Ala106 to Glu192-Glu210 which are partly located in the D-region. It is concluded that the urinary PCI-binding region to the B beta-chain resides in the sequence of Ala110 to Glu192-Glu210.

Pulmonary hypertension as a fatal complication of extrahepatic portal hypertension

Pulmonary hypertension is an uncommon complication of portal hypertension seen in cirrhotic as well as noncirrhotic patients. We report a 10-year-old girl who presented with extrahepatic portal hypertension and pulmonary hypertension in the absence of intrinsic liver disease. Further investigations revealed high serum concentrations of prostaglandin F2 alpha, thromboxane B2 in the inferior vena cava, and angiotensin I in the inferior vena cava and right ventricle. The increased levels of these vasoconstrictive substances strongly suggest that the possible mechanism for the pulmonary hypertension in such patients with extrahepatic portal hypertension include shunting of vasoactive agents from the splanchnic circulation to the pulmonary vascular bed.

[Helicobacter pylori infection in gastric cancer]

The relationship between Helicobacter pylori (H. pylori) infection and gastric cancer becomes the topics in the world, since some reports thereon in 1991. The purpose of this study was to know the prevalence of H. pylori infection in many patients with gastric cancer. We examined the H. pylori IgG antibody in 507 patients with gastric cancer resected surgically in our hospital from 1989 to 1991, retrospectively. For the test of H. pylori IgG antibody, HM-CAP EIA kit (Italy, ENTERIC PRODUCTS Co.) was used. The overall detection rate of H. pylori IgG antibody was 75% (378/507). H. pylori infection was significant significantly frequent in early cancer (80%, 231/288) than advanced cancer (67%, 147/219). But, the other clinicopathological features such as sex, age, histological type, location and the degree of intestinal metaplasia were not significantly correlated with H. pylori infection. To evaluate the risk of H. pylori infection for gastric cancer, we are going to plan a matched-pair case-control study.

Cyclosporine combined with methylprednisolone or methotrexate in prophylaxis of moderate to severe acute graft-versus-host disease

To evaluate the efficacy of cyclosporine (CYA) regimens in preventing moderate to severe acute graft-versus-host disease (GVHD), 25 patients received immunosuppressive therapy consisting of either CYA and methylprednisolone or CYA and methotrexate (MTX) and the incidence and severity of acute GVHD was compared. These patients had leukemia or myelodysplastic syndrome (MDS) and received bone marrow transplants (BMT) from genotypically HLA-identical siblings. The incidence of grade I-IV acute GVHD in patients on the CYA/methylprednisolone regimen was 64% (7 of 11) compared with 50% (7 of 14) in those on the CYA/MTX regimen. Five of 11 patients with the CYA/methylprednisolone regimen developed moderate to severe acute GVHD (grade II-IV), fatal in 3 cases. No patient on the CYA/MTX regimen developed moderate to severe acute GVHD. Engraftment was faster in the CYA/methylprednisolone group than in the CYA/MTX group. The incidence of toxicity observed soon after BMT was comparable between groups. The CYA/MTX regimen may be superior to the CYA/methylprednisolone regimen for preventing moderate to severe acute GVHD.

[Cytomegalovirus antigenemia in the differential diagnosis of pulmonary infiltrates after allogeneic bone marrow transplantation]

For the differential diagnosis of pulmonary infiltrates after bone marrow transplantation, cytomegalovirus (CMV) antigenemia was evaluated in 9 episodes of pneumonia which developed in 7 allogeneic marrow transplant patients between 9 and 495 days after transplant. The diagnosis of lung infiltration was made based on clinical findings including histological, cytological or microbiological examinations using bronchoalveolar lavage fluid specimens, sputum or lung tissue. The CMV antigen-positive leukocytes were detected with a direct immunoperoxidase technique using a peroxidase-labeled monoclonal antibody (HRP-C7) against CMV immediate early antigen. The episodes included 2 CMV pneumonias, 1 pneumocystis carinii pneumonia, 1 adenovirus pneumonia, 1 bacterial pneumonia, 1 bacterial and fungal pneumonia, 2 idiopathic pneumonias and 1 capillary leak syndrome associated with hyper acute GVHD. The CMV antigenemia became positive only in two patients with CMV pneumonia and the number of CMV antigen-positive leukocytes exceeded 10 per 50000 WBCs. The CMV antigenemia test required only 24 hours to obtain results. These observations suggest that the detection of CMV antigenemia is of great value in the differential diagnosis of pulmonary infiltrates in marrow transplant patients.

A synthetic peptide which specifically inhibits heat-treated interleukin-8 binding and chemotaxis for neutrophils

Interleukin-8 (IL-8) is a peptide which is secreted by stimulated human monocytes and which is chemotactic for human neutrophils. We synthesized three overlapping peptides spanning the amino-terminal region of the IL-8 sequence. None of the peptides retained the chemotactic activity of the native molecule. One of the peptides, IL-8(3-25), inhibited the neutrophil chemotactic activity of recombinant IL-8 (rIL-8) which had been preheated to 40 degrees C but did not reduce neutrophil chemokinesis, or the chemotactic activity of unheated rIL-8, FMLP, C5a or LTB4. Interleukin-8 exhibited similar binding kinetics and chemotaxis for neutrophils regardless of whether it had been pretreated at 40 degrees C. In addition, IL-8(3-25) was also able to decrease the binding of preheated IL-8 to neutrophils. IL-8(3-25), which can self-associate, binds directly to receptors on the neutrophil. The data suggest that heat-treated, but not untreated, IL-8 causes the IL-8(3-25) multimers to disaggregate, allowing the monomeric peptide to directly bind to the IL-8 receptor and thus inhibiting IL-8/receptor binding.