The brain finger protein gene (ZNF179), a member of the RING finger family, maps within the Smith-Magenis syndrome region at 17p11.2

Smith-Magenis syndrome (SMS) is caused by a microdeletion of 17p11.2 and comprises developmental and growth delay, facial abnormalities, unusual behavior and sleep problems. This phenotype may be due to haploinsufficiency of several contiguous genes. The human brain finger protein gene (ZNF179), a member of the RING finger protein family, has been isolated and mapped to 17p11.2. FISH analyses of metaphase or interphase chromosomes of 6 patients with SMS show that ZNF179 was deleted in one of the 2 homologs (17p11.2), indicating a possible association of the defect of this gene with the pathogenesis of SMS. Furthermore, using a prophase FISH ordering system, we sublocalized ZNF179 proximally to LLGL which lies on the critical region for SMS.

Early-childhood progressive myoclonus epilepsy presenting as partial seizures in dentatorubral-pallidoluysian atrophy

PURPOSE

We explored the characteristics of epileptic seizures of progressive myoclonus epilepsy (PME) in 2 brothers with dentatorubral-pallidoluysian atrophy (DRPLA).

METHODS

We obtained the case history of the siblings and ictal and interictal EEGs. Postmortem examination or demonstration of elongated CAG repeat in the gene for DRPLA was used to confirm the diagnosis.

RESULTS

Two Japanese siblings developed PME characterized by versive or himiclonic seizures with or without secondarily generalized tonic-clonic convulsions. The elder brother regressed mentally and exhibited increasing spasticity after age 1 year. Myoclonus and seizures developed at age 4 years. The younger brother had shown psychomotor retardation before age 4 years, when he began to deteriorate further neurologically as the elder brother had. He also developed myoclonus and seizures at that age. Seizures in both patients remained partial until their deaths at ages 19 and 15 years, respectively. Ictal EEG verified partial onset of seizure evolving to generalized tonic-clonic seizure (GTCS). Interictal EEGs showed multifocal paroxysmal discharges with little or no diffuse paroxysms. Postmortem examination or genetic study confirmed the diagnosis of DRPLA.

CONCLUSIONS

Seizures of patients with DRPLA may present as partial seizures in children with early-onset PME.

[Comparative histological analysis of needle biopsy specimens, prostatectomized specimens and metastatic lymph nodes in prostatic adenocarcinoma--on the basis of the WHO histological classification]

The histological characteristics were comparatively analyzed among biopsy specimens, surgically removed prostates and metastatic lymph nodes obtained from 60 patients with prostatic adenocarcinoma treated by radical prostatectomy. According to the WHO-Mostifi's classification, the proportion of the 6 histologic components, large and/or small simple glands (LSG), micro-glands (MIC), cribriorm (CRB), fused glands (FUS), medullary/solid (MED) and columns-cords/trabecular (C-C), was determined semiquantitatively. LSG, MIC, and CRB are androgen-sensitive components, while FUS, MED and C-C are androgen-refractory components. The proportions of 5 histologic components excluding MIC were similar in the biopsy and prostate specimens. In 78.3% of the patients, the presence (or absence) of androgen-refactory components in the biopsy specimens coincided with that in the prostate specimens. However, the histologic except for the C-C component. Metastatic lymph nodes contained androgen-refactory components in all cases and tended to have more CRB and FUS and fewer LSG. The histology of the needle biopsy specimens may reflect that of the prostate glands, and may serve as a valuable parameter for determining therapeutic modalities. In addition, androgen-refactory components are frequently present in lymph node metastasis.

Clinical spectrum and molecular diagnosis of Angelman and Prader-Willi syndrome patients with an imprinting mutation

Recent studies have identified a new class of Prader-Willi syndrome (PWS) and Angelman syndrome (AS) patients who have biparental inheritance, but neither the typical deletion nor uniparental disomy (UPD) or translocation. However, these patients have uniparental DNA methylation throughout 15q11-q13, and thus appear to have a mutation in the imprinting process for this region. Here we describe detailed clinical findings of five AS imprinting mutation patients (three families) and two PWS imprinting mutation patients (one new family). All these patients have essentially the classical clinical phenotype for the respective syndrome, except that the incidence of microcephaly is lower in imprinting mutation AS patients than in deletion AS patients. Furthermore, imprinting mutation AS and PWS patients do not typically have hypopigmentation, which is commonly found in patients with the usual large deletion. Molecular diagnosis of these cases is initially achieved by DNA methylation analyses of the DN34/ZNF127, PW71 (D15S63), and SNRPN loci. The latter two probes have clear advantages in the simple molecular diagnostic analysis of PWS and AS patients with an imprinting mutation, as has been found for typical deletion or UPD PWS and AS cases. With the recent finding of inherited microdeletions in PWS and AS imprinting mutation families, our studies define a new class of these two syndromes. The clinical and molecular identification of these PWS and AS patients has important genetic counseling consequences.

Mosaicism for del(17)(p11.2p11.2) underlying the Smith-Magenis syndrome

Smith-Magenis syndrome (SMS) is a multiple congenital anomalies/mental retardation syndrome associated with deletion of band p11.2 of chromosome 17. The deletion is typically detected by high-resolution cytogenetic analysis of chromosomes from peripheral lymphocytes. Fluorescence in situ hybridization (FISH) has been previously used to rule out apparent mosaicism for del(17)(p11.2p11.2) indicated by routine cytogenetics. We now report mosaicism for del(17)(p11.2p11.2) in a child with SMS. The mosaicism had gone undetected during previous routine cytogenetic analysis. FISH analysis of peripheral lymphocytes as well as immortalized lymphoblasts using markers from 17p11.2 revealed that approximately 60% of cells carried the deletion. To our knowledge, this is the first case of SMS associated with mosaicism for del(17)(p11.2p11.2).

Direct effects of estradiol and tamoxifen on gene expressions of inhibit alpha- and beta A-subunits in rat granulosa cells in vitro

To analyze direct effects of estrogen on gene expressions of inhibin subunits in vitro, the mRNA levels of inhibin alpha- and beta A-subunits were measured in rat granulosa cells cultured with FSH or estradiol. Through the culture process of the granulosa cells with serum-free medium, both the alpha- and beta A subunit mRNAs decreased, and were partially increased again by adding FSH to the culture medium. To examine whether these FSH effects are mediated via estrogen production, estradiol or tamoxifen was added to the cultured granulosa cells. After 36-h culture with estradiol, the inhibin alpha-subunit decreased but the inhibin beta A-subunit increased, in a dose-responsive manner. Tamoxifen showed completely opposite effects to estradiol, and a combination of estradiol and tamoxifen resulted in similar levels of inhibin-alpha and -beta A mRNAs to the control. These results indicate that estrogen would by a certain pathway affect gene expressions of the inhibin subunits in the rat granulosa cells, and may regulate the production of inhibin and activin through the paracrine system.

[Cerebral oxygen desaturation during rewarming in retrograde cerebral perfusion with total circulatory arrest]

To evaluate cerebral oxygen desaturation during retrograde cerebral perfusion with total circulatory arrest (RCP), we measured cerebral oxygen extraction (O2 Ext), and arterio-venous oxygen differences (AV DO2) during and after RCP and compared the results with usual cardiopulmonary bypass (CPB) using continuous jugular blood saturation (SjO2) monitoring. In the RCP group, 7 patients underwent aortic arch replacement with RCP and in the CPB group, 4 patients underwent valvular surgery with CPB. A 5.5 Fr oximetric catheter was placed in the jugular bulb and cerebral venous and radial arterial blood were sampled. Oxygen partial pressure and saturation were measured at six intervals from cerebral venous and radial arterial blood. Measurements were taken at the following phases: phase I: before ECC was established, phase II: immediately after ECC started; phase III: at hypothermia (18 degrees C in the RCP group and 28 degrees C in the CPB group), phase IV: during rewarming (30 degrees C), phase V: after rewarming (36 degrees C), phase IV: immediately after weaning from ECC. All 11 patients survived without neurological complications. The minimum SjO2 of continuous monitoring during rewarming in the RCP group was significantly lower than in the CPB group. AVDO2 in the RCP group was also significantly higher than in the CPB group during rewarming. O2 Ext in the RCP group was significantly higher than in the CPB group during and after rewarming. Differences in glucose utilization during and after rewarming were also detected. Moreover, to determine factors that influence SjO2 during and after rewarming, we evaluated correlations with arterial PaCO2, arterial pH, and rewarming duration. There were significant (p < 0.05) correlations between SjO2 and PaCO2 in phase IV and phase V, between SjO2 and pH, and between SjO2 and rewarming duration. In conclusion, continuous SjO2 measurements reflected cerebral oxygen desaturation during and after rewarming in RCP. In RCP, significantly greater desaturation during and after rewarming was detected than in CPB. Therefore we suggest that relatively slow rewarming, higher PaCO2, and more acidic pH strategies were advantageous for preventing desaturation during and after rewarming in RCP.

Nitric oxide plays a key role in adaptive control of locomotion in cat

Diverse roles in cellular functions have been ascribed to nitric oxide (NO), and its involvement in induction of long-term depression in cerebellar Purkinje cells has been demonstrated. Manipulations of NO concentration or its synthesis in cerebellar tissues therefore provide a means for investigating roles of NO in cerebellar functions at both cellular and behavioral levels. We tested adaptive control of locomotion to perturbation in cats, and found that this form of motor learning was abolished by application of either an inhibitor of NO synthase or a scavenger of NO to the cerebellar cortical locomotion area. This finding supports the view that NO in the cerebellum plays a key role in motor learning.

Successful glucocorticoid treatment for patients with abnormal autoimmunity on in vitro fertilization and embryo transfer

PURPOSE

To analyze the effects of glucocorticoid treatment for patients with abnormal autoimmunity on IVF-ET outcomes, low-dose predonisolone or dexamethasone was administered in 51 IVF-ET cycles of 41 patients with positive antinuclear antibody (ANA), anti-DNA antibody, and/or lupus anticoagulant (LAC). Rates of clinical pregnancy and implantation in these patients were compared with those in 48 cycles without corticosteroid therapy. Autoantibody-negative patients were also treated with IVF-ET combined with (29 cycles) or without (57 cycles) glucocorticoid administration, and the pregnancy and implantation rates were investigated.

RESULTS

Without glucocorticoid treatment, the pregnancy rate per cycle and implantation rate per embryo in antibody-positive patients were 10.4 and 3.8%, respectively. Significant increases in pregnancy (35.3%) and implantation (13.2%) rates were observed with corticosteroid treatment. In antibody-negative patients, the rates of pregnancy and implantation showed no significant differences with versus without the glucocorticoid administration.

CONCLUSIONS

Our results indicate that because autoimmune abnormalities may be at least one cause of implantation failure following IVF-ET, the combined use of low-dose corticosteroid can be effective for autoantibody-positive women.

[Combination therapy with 5-fluorouracil (5-FU), cisplatin (CDDP) and interferon alpha-2B (IFN alpha-2B) for advanced renal cell carcinoma]

Eleven patients with metastatic renal cell carcinoma received combination therapy with 5-fluorouracil (5-FU), Cisplatin (CDDP) and Interferon alpha-2b (IFN alpha-2b). For 5 days, 500 mg of 5-FU was administered by continuous intravenous infusion daily; 20 mg/m2 CDDP was injected intravenously daily for 5 days, and 3 or 6 million units of IFN alpha-2b was administered intramuscularly twice a week for 3 weeks. This treatment cycle was repeated every 3 weeks. One of 11 patients achieved a partial response, and the response rate was 9%. High grade toxicities (WHO grade 3 or 4), nausea and vomiting (27%), leukocytopenia (9%), anemia (9%) and thrombocytopenia (18%) were seen. One of the reasons that this regimen dose not appear to be effective may be the low total dose of 5-FU for renal cell carcinoma.

Characteristic evoked potentials in childhood-onset dentatorubral-pallidoluysian atrophy

To determine the characteristics of multimodal evoked potentials (MEPs) in childhood-onset dentatorubral-palli-doluysian atrophy (DRPLA) we studied three DRPLA patients with progressive myoclonus epilepsy. Brainstem auditory evoked potentials showed reduced or absent brainstem components as well as delayed latencies. In addition, short latency somatosensory evoked potentials (S-SEPs) had prolonged central conduction time and reduced amplitude of cortical components. Two patients with symptom onset in the first decade of life had extremely enlarged flash visual evoked potentials with shortened latency even in the absence of giant SEPs. Therefore, children with progressive myoclonus epilepsy and the above MEP findings are likely candidates for childhood-onset DRPLA and should undergo DNA analysis for DRPLA.

Dynamic mutation loci: allele distributions in different populations

To assess the relative contributions of trans-acting factors (replication and repair functions) and cis-acting elements (repeat and flanking DNA composition) to the mechanism of trinucleotide repeat sequence mutation we have analysed the distribution of copy number polymorphisms at 12 loci associated with dynamic mutations in 15 populations of different ethnic origins. Genome wide instability of repeats in a particular population would be evidence of trans-acting factor instigation of the mutation process, whereas instability at a particular locus (perhaps even in several populations) would be evidence that the composition of the particular locus was the most significant factor contributing to mutation. The FRA16A locus is highly polymorphic in only the European population. Some other loci exhibit distinct distributions of alleles between different populations. Therefore sequences in the vicinity of the repeat -- the cis component of a particular locus -- appear(s) to be more important in the mutation mechanism than sporadic genome-wide instability induced by trans-acting factors such as the DNA mismatch repair enzymes.

Genetic association between cytochrome P450IA1 gene and susceptibility to Parkinson's disease

Idiopathic Parkinson's disease (PD) is a multifactorial neuro-degenerative disorder resulting from environmental factors acting on genetically susceptible individuals with normal aging. Cytochrome P450IA1 is a dioxin-inducible enzyme which is responsible for the activation of procarcinogens and environmental pollutants, such as benzo[alpha]pyrene and other aromatic hydrocarbons. The frequencies of polymorphic alleles of cytochrome P450IA1 gene (CYPIA1) were studied in 126 unrelated patients with PD in comparison with 176 healthy Japanese. The frequency of the Msp I polymorphic allele, a variant of CYPIA1 (m2), was significantly higher in patients with PD (0.444) than in controls (0.349). The risk of PD in homozygotes for m2 was 2.34-fold greater than homozygotes for the wild-type, m1. The relative risk for PD in homozygotes for CYPIA1Val was 6.54-fold higher than in homozygotes for the wild type (CYPIA1Ile)(p < 0.001). These results strongly suggest that the CYPIA1 might be one of the susceptibility genes for PD.

Evidence that poor metabolizers of (S)-mephenytoin could be identified by haplotypes of CYP2C19 in Japanese

(S)-Mephenytoin is metabolized by CYP2C19. The purpose of this study was to examine availability of phenotyping of poor metabolizers (PMs) of (S)-mephenytoin by polymerase chain reaction (PCR)/restriction enzyme genotyping of CYP2C19 in a Japanese population. We genotyped 217 unrelated healthy Japanese for functionally defective alleles, CYP2C19m1 and CYP2C19m2. The frequencies of the wild type(wm1) and CYP2C19m1 were 0.726 and 0.274, and the wild type(wm2) and CYP2C19m2 were 0.892 and 0.108 respectively. Although the observed numbers of three genotypes were very similar to those estimated according to the Hardy-Weinberg equilibrium for each defect, CYP2C19m2 was not detected in m1 homozygotes, and CYP2C19m1 was not detected in m2 homozygotes. Two defects were inherited separately in four families indicating CYP2C19m1 and m2 segregate independently at the same gene locus. Based on these data, we calculated the haplotype frequencies of wm1-wm2, CYP2C19m1-wm2 and wm1-CYP2C19m2 to be 0.618, 0.274 and 0.108 respectively. Frequencies of homozygotes for CYP2C19m1 and CYP2C19m2 and compound heterozygotes associated with the PM phenotype, were calculated to be 7.5, 1.2 and 5.9% respectively. In total, 14.6% of Japanese are estimated to be PMs. No significant difference was observed between the frequencies of PMs calculated from our results and that identified by urinary S/R ratio (18%) (p > 0.05, chi 2 = 0.545, fd = 1). Our data indicate that Japanese PMs of (S)-mephenytoin could be identified by PCR-based genotyping of CYP2C19.

Metastatic choriocarcinoma of the kidney discovered by refractory hematuria

A case of metastatic choriocarcinoma of the kidney is reported. A 34-year-old married woman was referred to our department complaining of gross hematuria, fever and loin pain. Computed tomography revealed a right renal tumor with mixed density and multiple lung metastases. We performed nephrectomy to control refractory hematuria. The histological diagnosis of the tumor was metastatic choriocarcinoma. In young women, with gross hematuria, menstrual irregularity and atypical renal tumor with multiple lung metastases, metastatic choriocarcinoma of the kidney should be suspected.

[Combination therapy with estrogen and UFT in newly diagnosed prostatic cancer (poorly differentiated, stage D2)]

To determine whether long-term oral administration of UFT, a combination of 5-fluorouracil and uracil, in addition to conventional estrogen therapy improved the response and survival of the patients with advanced stage D2 prostate adenocarcinoma, a randomized prospective study was performed with either estrogen alone (Honvan 200 mg/day or presexol 1 mg/day: group A) or estrogen plus UFT (400 mg/day:group B). This study comprises 34 newly diagnosed patients with poorly differentiated prostatic adenocarcinoma (18 patients in group A and 16 in group B). Survival from all causes of death or cancer-specific death were compared using Kaplan-Meier actual methods among the patients separated by histological composition of tumors analyzed WHO histologic patterns, score of extent of disease (EOD), and with or without normalization of serum PSA or PAP levels after treatment. Although combination therapy with UFT against overall survival was effective without statistical significance, better survival in this group than the patients treatment with estrogen alone assessed among the patients whose tumor contained more than 70% of medullary and/or column-cord histological components. The survivals among the patients with EOD score 3 and whose serum PSA or PAP levels did not lead to decrease within normal levels after treatment were also better in group B than in group A. These findings suggest the validity of the combination therapy with UFT in addition to estrogen against highly advanced prostatic cancer patients whose tumor composed of abundant non-hormone-refractor histological components.

Clinical factors for successful cryopreserved-thawed embryo transfer

PURPOSE

To study how clinical factors such as embryo quality, cell stage of embryo at cryopreservation, and synchronization of developmental stages between embryo and endometrium at thawing affect the implantation rate after cryopreserved-thawed embryo transfer (ET), these factors were examined in 106 cryopreserved-thawed ETs including 204 embryos.

RESULTS

In 86 embryos graded as high quality before transfer by morphological evaluation, 31 implantations were successful, while the other, low-quality embryos did not implant at all. High-quality embryos received less cryoinjury during cryopreservation compared to the injuries sustained by embryos in moderate and poor quality. When cyopreservation was performed at the 1-, 2-, and 3-day cell stages, pregnancies were similiarly achieved among most of the embryos at all cell stages. At thawed ETs in natural ovulation cycles, there were some differences among the developmental stages between thawed embryo and endometrium that received the thawed transferred embryos. Although the transfer timelag ranged a day or more, asynchronism of endometrium growth to the cell stage did not reduce pregnancy rates.

CONCLUSIONS

These results indicated that embryo quality evaluated morphologically was the most important clinical factor for successful implantation of cryopreserved-thawed ET.

A unique origin and multistep process for the generation of expanded DRPLA triplet repeats

Dentatorubral and pallidoluysian atrophy (DRPLA) is an autosomal dominant neurodegenerative disorder associated with the expansion of a CAG repeat at chromosome band 12p13. Epidemiological studies have demonstrated an increased prevalence of DRPLA in Japan, although several DRPLA kindreds of non-Japanese ancestry have been identified. To define the molecular basis for this geographic variation in prevalence, we have analyzed haplotypes around the repeat in several different ethnic groups. Two intragenic biallelic polymorphisms distinguished three haplotypes, each of which formed a predominant haplotype found in the three major racial populations. All the expanded repeats of Japanese and Caucasian patients studied were associated with a particular haplotype, which otherwise was associated with longer repeats commonly found in Asians. Our results support a multi-step model for repeat expansion, and suggest that expanded DRPLA repeats may have evolved from an ancient chromosomal haplotype of Asian origin. We also propose that a combination of a highly polymorphic microsatellite marker with relatively stable biallelic markers in a range of PCR amplification is a powerful tool for studies on human genome diversity, which may reveal the ancient human migration and the formation of ethnic groups.

Proton magnetic resonance spectroscopy on childhood-onset dentatorubral-pallidoluysian atrophy (DRPLA)

To evaluate brain dysfunction of childhood-onset dentatorubral-pallidoluysian atrophy (DRPLA), three children with progressive myoclonus epilepsy, who were diagnosed as having DRPLA by DNA analysis, for the first time, underwent a study of proton magnetic resonance spectroscopy (1H-MRS). 1H-MRS obtained from both the parietal and basal ganglia regions disclosed markedly reduced ratios of N-acetylaspartate to both choline and creatine. Especially regarding the basal ganglia region, the latter (ratio of N-acetylaspartate to creatine) closely correlated to severity of genetic abnormality, i.e. number of expanded CAG repeats, suggesting that the degree of neuronal loss in the region strongly depends on genetic factors. 1H-MRS must be a valuable tool to clarify the pathophysiology of DRPLA.

Benign adult familial myoclonus epilepsy (BAFME): an autosomal dominant form not linked to the dentatorubral pallidoluysian atrophy (DRPLA) gene

The genetic differences between two types of dominant inherited myoclonus epilepsy, dentatorubral pallidoluysian atrophy (DRPLA) and benign adult familial myoclonus epilepsy (BAFME), have been reported. A gene with a CAG repeat expansion responsible for DRPLA has been isolated. We have examined CAG repeat expansion in the DRPLA gene in five BAFME families, and the abnormal CAG expansion was not observed in the affected subjects. Linkage analysis using DNA polymorphisms in the DRPLA gene and the genes for gamma-aminobutyric acid (GABA) receptor subunits, GABAR beta 1, GABAR beta 3, and GABAR alpha 6, showed that these genes were not responsible for BAFME.

Pyridinium cross-links as urinary markers of bone metastases in patients with prostate cancer

OBJECTIVES

To determine whether the urinary excretion of urinary pyridinoline (Py) and deoxypyridinoline (dPy) serve as markers to evaluate the activity of bone metastases and the response to endocrine therapy, by determining the relationship between the excretion of these compounds and the activity of bone metastases in patients with prostate cancer.

PATIENTS AND METHODS

Urine specimens were obtained from 15 patients with benign prostatic hypertrophy (BPH), 17 with carcinoma clinically confined to the prostate and 26 with prostate cancer and bone metastases. Among the patients with prostate cancer and bone metastases, 15 were new or reactivated cases and the 11 others were well controlled by hormonal therapy. Urinary Py and dPy were analysed using high-pressure liquid chromatography.

RESULTS

Patient with new or reactivated prostate cancer with bone metastases had a higher urinary excretion of Py and dPy than did the patients with BPH, patients with prostate cancer and no bone metastases and patients with prostate cancer and bone metastases well controlled with hormonal therapy. Urinary levels of these compounds correlated with the extent of bone metastases in new and reactivated cases. Initial high levels of these cross-linked compounds in patients with multiple bone metastases fell as the prostate cancer was controlled by hormonal therapy.

CONCLUSION

Urinary excretion of Py and Dpy appears to be a useful marker for evaluating the activity of bone metastases and their response to hormonal treatment in prostate cancer.