Up-regulation of TRAIL mRNA expression in peripheral blood mononuclear cells from patients with active systemic lupus erythematosus

It is recently suggested that tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) is involved in the pathogenesis of systemic lupus erythematosus (SLE). In this study, we examined whether expression levels of TRAIL depend on SLE activity. To estimate TRAIL mRNA expression levels in peripheral blood mononuclear cells (PBMC), we performed quantitative real-time reverse transcription-polymerase chain reaction analyses of PBMC from 18 SLE patients and 20 healthy subjects. Serum soluble TRAIL (sTRAIL) concentrations were measured by an enzyme-linked immunosorbent assay. The mean TRAIL mRNA expression level and serum sTRAIL concentration in SLE patients were significantly higher than those in healthy controls. Expression levels of TRAIL mRNA correlated with the SLE disease activity index and circulating immune complexes levels, while serum sTRAIL concentrations did not. These results indicate that increased expression of TRAIL mRNA in PBMC closely correlates with SLE activity and suggest an important role for TRAIL in the pathogenesis of SLE.

Increased Serotonergic Innervation of Lumbosacral Motoneurons of Rolling Mouse Nagoya in Correlation with Abnormal Hindlimb Extension

Rolling Mouse Nagoya (RMN) carries a mutation in a gene encoding for alpha(1A) subunit of P/Q-type Ca(2+) channel (Ca(v)2.1). In addition to ataxia, this mutant mouse exhibits abnormal hindlimb extension, which is characterized by a sustained excessive tone of hindlimb extensor muscles. This study aimed to clarify whether serotonergic (5-HTergic) innervation of the spinal motoneurons was altered in RMN in relation to the abnormal hindlimb extension. The density of 5-HT immunoreactive fibres in the ventral horn of lumbar and sacral regions of spinal cord was significantly greater in RMN than in controls. Retrograde wheat germ agglutinin-conjugated horseradish peroxidase (WGA-HRP) labelling combined with 5-HT immunostaining revealed that the number of 5-HT immunoreactive terminals adjoining femoris quadriceps motoneurons was about 2.5-fold greater in RMN than in controls. Furthermore, 5-HT immunostaining in the lumbar cord ventral horn was examined in three other Ca(v)2.1 mutant mice (tottering, leaner and pogo) as to whether or not they showed the abnormal hindlimb extension. Among these mutants, the increased density of 5-HT immunoreactive fibres was observed in correlation with the presence of the abnormal hindlimb extension. The results suggest an increased 5-HTergic innervation of the lumbosacral motoneurons in correlation with the abnormal hindlimb extension in RMN and other Ca(v)2.1 mutant mice. As 5-HT is known to induce the sustained membrane depolarizations without continuous excitatory synaptic inputs (plateau potentials) in spinal motoneurons, the increased 5-HTergic innervation may cause the sustained excitation of hindlimb extensor motoneurons, resulting in the abnormal hindlimb extension.

Increased serum levels of S100A12 in patients with MPO-ANCA-associated glomerulonephritis

BACKGROUND

Increased serum levels of S100A12, a proinflammatory protein secreted by activated neutrophils, have recently been shown in patients with active inflammatory diseases, such as rheumatoid arthritis and Kawasaki disease. In this study, we investigated serum levels of S100A 12 in patients with small-vessel vasculitis, myeloperoxidase anti-neutrophil cytoplasmic antibodies- (MPO-ANCA) associated pauci-immune glomerulonephritis.

METHODS

Serum S100A12 concentrations were measured by a sandwich enzyme-linked immunosorbent assay (ELISA) in 46 patients with MPO-ANCA-associated glomerulonephritis and 29 healthy controls. We analyzed correlations between serum S100A12 levels and a clinical index of vasculitis activity, the Birmingham Vasculitis Activity Score (BVAS), various laboratory parameters, and pathological activity scores in the patients. We also analyzed changes of serum S100A12 levels in 10 patients after treatment.

RESULTS

ELISA showed about 4-fold higher levels of serum S100A12 in patients with MPO-ANCA-associated glomerulonephritis than healthy controls. Serum S100A12 levels correlated with the BVAS scores, the peripheral white blood cell count, levels of serum C-reactive protein and creatinine, and pathological activity scores in the patients, but did not correlate with serum MPO-ANCA titers. Serum S100A12 levels after treatment decreased in all the 10 patients examined.

CONCLUSION

We demonstrated that increased serum S100A12 levels correlate with clinical, laboratory and pathological parameters of disease activity in patients with MPO-ANCA-associated glomerulonephritis. Serum S100A12 level may be one of the useful markers of disease activity in MPO-ANCA-associated glomerulonephritis.

Development of cerebral sulci and gyri in fetuses of cynomolgus monkeys (Macaca fascicularis)

This study aimed to clarify the development of sulci and gyri on the external surface of the cerebrum of cynomolgus monkeys. Sulcus formation began with the appearance of the lateral fissure on embryonic day (ED) 70, followed by delineations of four cerebral lobes by the emergence of the parietooccipital sulcus, central sulcus, and preoccipital notch on EDs 80-90. The following primary sulci were then visible until ED 120: the superior temporal sulcus on ED 90; the intraparietal sulcus, lunate sulcus, inferior occipital sulcus, and arcuate sulcus on ED 100; and the principle sulcus on ED 110; the occipitotemporal sulcus, anterior middle temporal sulcus, and superior postcentral dimple on ED 120. These sulci demarcated the superior temporal gyrus on ED 90, the precentral gyrus, supramarginal gyrus, and angular gyrus on ED 100, and the inferior and middle temporal gyri, postocentral gyrus, superior parietal lobule, superior, middle and inferior frontal gyri, and inferior occipital gyrus on ED 120. Except for the intermediate and lateral orbitofrontal sulci, the sulci that appeared on ED 130 and thereafter were not related to the gyrus demarcations. Intriguingly, the brain markedly gained weight on EDs 100 and 120, corresponding to the embryonic ages when almost all gyri were visible. The results suggest that a rapid growth of the cerebrum involves convolutions of the gyri by a regular sequence of the sulcus formation in cynomolgus monkeys. This study further provides a standard of reference for normal development in the cerebral cortical morphology of cynomolgus monkeys.

The absence of phosphorylated tyrosine hydroxylase expression in the purkinje cells of the ataxic mutant pogo mouse

The pogo mouse is a new ataxic autosomal recessive mutant that arose in Korean wild mice (KJR/Mskist). Its ataxic phenotype includes difficulty in maintaining a normal posture and the inability to walk in a straight line. Several studies have reported that tyrosine hydroxylase (TH) is persistently ectopically expressed in particular subsets of Purkinje cells in a parasagittal banding pattern in several ataxic mutant mice, e.g. tottering alleles and pogo mice. In this present study, we examined the expression of an enzymatically active form of TH and phosphorylated TH at Ser(40) (phospho-TH) by using immunohistochemistry and double immunofluorescence in the cerebellum of pogo mice. TH immunostaining appeared in some Purkinje cells in pogo, but in only a few of Purkinje cells of their heterozygous littermate controls. In all groups of mice, no phospho-TH immunoreactive Purkinje cells were observed in the cerebellum, although subsets of TH immunoreactive Purkinje cells were found in adjacent sections. This study suggests that TH expression in the Purkinje cells of pogo abnormally increases without activation of this enzyme by phosphorylation. This may mean that TH in the Purkinje cells of these mutants does not catalyse the conversion of tyrosine to l-DOPA, and is not related to catecholamine synthesis.

The thickness of the roof of the glenoid fossa in the temporomandibular joint: relationship to the MRI findings

OBJECTIVES

The purpose of this study was to clarify the relationship between the thickness of the roof of the glenoid fossa (RGF) and magnetic resonance imaging (MRI) findings of temporomandibular joint (TMJ) disorders (TMDs).

METHODS

Eighty-seven patients with symptoms and indications of TMD in one or both TMJs were referred for MRI. Cone-beam CT (3DX) was used to measure the thickness of the RGF at its thinnest point. Linear measurements were made three times on the monitor by three separate investigators and the mean values obtained were used for the statistical analyses.

RESULTS

The joints were categorised as normal (70 joints), anterior disc displacement with reduction (ADWR; 53 joints) or anterior disc displacement without reduction (ADWOR; 51 joints). The joint disorders were also categorised into the following subgroups: with osteoarthritis (OA) (21 joints), without OA (153 joints), with disc deformation (33 joints), without disc deformation (141 joints), with joint effusion (JE) (61 joints) and without JE (113 joints). The average minimum thickness of the RGF was 0.85 mm for normal joints, 0.90 mm with ADWR, 0.93 mm with ADWOR, 0.99 mm with OA, 0.87 mm without OA, 0.87 mm with disc deformation and 0.89 mm without disc deformation. There was no significant difference between these figures. There was a significant difference in the thickness of the RGF with (0.97 mm) and without (0.84 mm) JE.

CONCLUSIONS

These results suggest that RGF thickness is influenced by JE, but is unaffected by disc position and configuration.

Analysis of the NPHP genes in two Japanese patients with suspected sporadic juvenile or adolescent nephronophthisis

BACKGROUND

Mutations in 3 genes (NPHP1, NPHP3 and NPHP4) have been identified in patients with juvenile or adolescent nephronophthisis (NPHP) without extrarenal involvement, mainly in patients from western countries. In this study, we analyzed mutations in the NPHP genes of 2 Japanese patients with suspected sporadic juvenile or adolescent NPHP without extrarenal involvement.

METHODS

A renal biopsy was performed in the 2 patients. Genomic DNA was prepared from peripheral blood mononuclear cells of the patients and their family members. The above NPHP genes were examined by deletion analysis or direct automated sequencing of polymerase chain reaction-amplified DNA products.

RESULTS

Histological findings in the patients were compatible with those of NPHP. In 1 patient, we identified a novel deletion mutation including about half of exons of the NPHP1 gene. In another patient, there was no mutation in the NPHP genes examined.

CONCLUSIONS

We found a novel NPHP1 deletion in 1 patient. To our knowledge, this is the second Japanese NPHP case in which genetic diagnosis was made.

Corticotropin-Releasing Factor Immunoreactivity Increases in the Cerebellar Climbing Fibers in the Novel Ataxic Mutant Mouse, Pogo

The ataxic pogo mouse (pogo/pogo) is a novel neurological mutant, which was derived as an inbred strain (KJR/MsKist) from a Korean wild mouse. The pathological manifestations include a difficulty in maintaining a normal posture, the failure of inter-limb coordination and an inability to walk straight. In this study, we examined the distribution of corticotropin-releasing factor (CRF) immunoreactive cerebellar climbing fibres and their projections to tyrosine hydroxylase (TH) immunoreactive Purkinje cells in the cerebellum of the pogo mutant mouse using immunohistochemistry. In the pogo/pogo mouse, a subset of climbing fibres was stained more intensely for CRF than in the control. Moreover, ataxic pogo mouse, neurons of the inferior olivary nucleus projecting climbing fibres were also more intensely stained for CRF than in the control. In the pogo/pogo mouse, TH immunoreactivity was located in the Purkinje cells, whereas no TH expression was found in the control. Double immunostaining for CRF and TH in the pogo/pogo cerebellum revealed that the distribution of TH-immunoreactive Purkinje cells corresponded to terminal fields of CRF-immunoreactive climbing fibres but not to the CRF-immunoreactive mossy fibres. Therefore, we suggest that an increase of CRF level may alter the function of targeted Purkinje cells and that it is related to the ataxic phenotype in the pogo mutant mouse.

Pharmacokinetic mass of fentanyl for postoperative analgesia in lean and obese patients † †Presented in abstract form at the Annual Meeting of the American Society of Anesthesiologists, Las Vegas, October 26, 2004

BACKGROUND

We previously proposed dosing weights for fentanyl, termed 'pharmacokinetic mass', that span the total body weight (TBW) range from 40 to 210 kg. In this study, we examined the relationships among fentanyl doses needed to achieve postoperative analgesia, corresponding plasma fentanyl concentrations, and pharmacokinetic mass in lean and obese patients undergoing abdominal surgery.

METHODS

A total of 69 patients were studied, with TBW ranging from 48 to 181 kg. Fentanyl infusion was used during surgery. After surgery, fentanyl infusion rates were titrated to achieve analgesia without significant respiratory depression. Plasma fentanyl concentrations were measured when an apparent steady analgesic state was obtained. Comparisons were made for dosing requirements and effective plasma concentrations for 37 lean patients (body mass index < 30, TBW < 85 kg) and 33 obese patients (body mass index > 30, TBW > or = 85 kg).

RESULTS

The average fentanyl dose (microg h(-1)) required to achieve and maintain analgesia over the 4 h postoperative period had a non-linear relationship to TBW; in comparison, fentanyl dose had a strong linear relationship to pharmacokinetic mass: dose (microg h(-1)) = 1.22 x pharmacokinetic mass - 7.5; r = 0.741, P < 0.001. Based on results from our earlier study, the corresponding values of TBW and pharmacokinetic mass are: 52 kg--52 kg; 70 kg--65 kg; 100 kg--83 kg; 120 kg--93 kg; 140 kg--99 kg; 160 kg--104 kg; 180 kg--107 kg; 200 kg--109 kg. In the group comparisons, there was no statistically significant difference in the postoperative fentanyl dose per unit of pharmacokinetic mass between lean and obese patients. The plasma concentration of fentanyl required for analgesia was approximately 1.5 ng ml(-1), and was similar in the two groups.

CONCLUSION

The relationship between dose and pharmacokinetic mass, compared with that of dose vs TBW, may provide confidence for the use of pharmacokinetic mass as a dosing approximation for fentanyl. Fentanyl dose based on TBW may cause overdosing in obese patients.

Evaluation of the usefulness of the limited cone-beam CT (3DX) in the assessment of the thickness of the roof of the glenoid fossa of the temporomandibular joint

OBJECTIVES

The purpose of this study was to evaluate the usefulness of the limited cone-beam X-ray CT (3DX) (Morita Co., Japan) in measuring the thickness of the roof of the glenoid fossa (RGF) of the temporomandibular joint (TMJ).

MATERIALS AND METHODS

Twenty-one TMJs removed at autopsy from 21 cadavers were investigated macroscopically using dissection and 3DX imaging. A Digimatic Outside Micrometer and a 3DX-image tool were used to measure the minimum thickness of the RGF. Multiple measurements were made to identify the thinnest area. Once the thinnest areas had been identified, three linear measurements were made and the average value was used for statistical analysis.

RESULTS

The average macroscopic examination measurement was 1.37 mm (range 0.55-3.6 mm) and the average 3DX image measurement was 1.22 mm (range: 0.51-3.0 mm). There was no significant difference between these two groups using the Mann-Whitney U-test (P < 0.05). The Spearman's correlation coefficient by rank between these two groups was r = 0.93(P < 0.001).

CONCLUSION

These results suggest that bone thickness measurements of the RGF by 3DX imaging was effective.

Selective granulocyte and monocyte apheresis as a new adjunct to enhance the efficacy of interferon-alpha + ribavirin in patients with high plasma hepatitis C virus

BACKGROUND AND AIM

Selective granulocyte and monocyte/macrophage adsorptive apheresis is to increase the turnover of infected leucocytes and has increased CD4+ T cells, which are necessary for actions of interferon-alpha on hepatitis C virus. Therefore, granulocyte and monocyte apheresis was to enhance the efficacy of interferon + ribavirin.

METHODS

Fifteen patients, 12 had interferon resistant hepatitis C virus and 3 were interferon naive. Hepatitis C virus genotype was 1b in 11 and 2a in 4. The mean plasma HCV-RNA was 728.3 kU/mL and alanine aminotransferase was 107.5 U/L. Granulocyte and monocyte apheresis was with the Adacolumn, which contains carriers that adsorb granulocytes and monocytes/macrophages. After five consecutive granulocyte and monocyte apheresis sessions over 5 days, interferon daily 6 million units for 4 weeks, then three times/week for 20 weeks+ribavirin (600-800 mg per patient per day) were given and followed for another 24 weeks.

RESULTS

During granulocyte and monocyte apheresis, plasma HCV-RNA transiently fell by up to 55%. Similarly, incubation of blood with the Adacolumn carriers caused a significant fall in HCV-RNA. Four patients were unavailable for efficacy evaluation. In the other 11, alanine aminotransferase normalised and at 11 weeks, plasma HCV-RNA was negative; six of these (55%) maintained their remission during the follow up.

CONCLUSION

Granulocyte and monocyte apheresis appears to deplete extra-hepatic hepatitis C virus reservoirs and generate active complement opsonins, which contribute to hepatitis C virus killing. Additional mechanism(s) are also likely and need to be elucidated in future studies with larger cohort of patients.

Immunomodulatory effects of selective leucocytapheresis as a new adjunct to interferon-alpha2b plus ribavirin combination therapy: a prospective study in patients with high plasma HCV viraemia

Efficacy of interferon-alpha2b (IFN) + ribavirin (IFN/RBV) combination in patients with high plasma hepatitis C virus (HCV) is very poor. Dysregulated CD4+ /CD8+ T cells is involved in both impaired cell-mediated immunity and resistance to IFN. Adsorptive granulocytes and monocytes apheresis (GMA) can remove infected leucocytes which are extrahepatic HCV reservoirs and also has been associated with intriguing immunomodulation and increases in CD4+ T cells. Our aim was to see if GMA enhances the efficacy of IFN/RBV. Twenty-four patients, 13 IFN resistant and 11 IFN naive were enrolled. Seventeen were genotype 1b and 7 were 2a or 2b. Mean plasma HCV-RNA was 612.9 (100-850) kIU/mL and alanine aminotransferase, 108 (41-373) U/L. GMA was performed with Adacolumn at one session/day for five consecutive days and IFN/RBV was started within 24 h after the last GMA session. Daily 6 million units of IFN, six times/week for 2 weeks and then three times/week for 22 weeks were given with RBV (600-800 mg/day/patient). Patients were followed for 6 months. GMA was associated with a significant increase in lymphocyte counts, complement activation fragment C3a and falls in tissue necrosis factor-alpha, and IL-8 produced by peripheral blood leucocytes. At week 24, 20 of 24 patients (83%) were HCV negative and by end of follow-up (week 49), the remission was sustained in 14 of 24 patients (58%) including 100% of patients with 2a or 2b. In conclusion, enhanced efficacy of IFN/RBV following GMA might be attributed to a more efficient immune function and a renewed IFN signaling towards HCV.

A nonsense mutation (R220X) in the alpha-galactosidase A gene causes typical Fabry disease in both genders

BACKGROUND

Fabry disease is an X-linked recessive disorder resulting from a deficiency of lysosomal alpha-galactosidase A (alpha-Gal A). Chronic renal failure is an important cause of death in patients with Fabry disease. We report on patients with Fabry disease (a hemizygous male and his mother) due to a nonsense mutation (R220X) in the alpha-Gal A gene.

METHODS

The proband, a 41-year-old man, and his 71-year-old mother presented with renal and cardiac manifestations of Fabry disease. Histological examination and molecular analysis of the alpha-Gal A gene were performed.

RESULTS

Typical histological findings of Fabry disease were observed in a renal biopsy specimen from the proband and in renal and myocardial necropsy specimens from the mother. Sequencing of a full-length alpha-Gal A cDNA from the proband indicated a C-T transition at codon 220, resulting in substitution of the predictable termination for arginine (R220X). Examination of genomic alpha-Gal A DNA revealed that the proband was a hemizygote and the mother was a heterozygous carrier for the mutation.

CONCLUSION

This is the first detailed report of family members with Fabry disease due to a nonsense mutation (R220X) in the alpha-Gal A gene. Our study indicates that this mutation causes the typical disease in both genders.

Adsorption of lanthanoid ions on calcite

The adsorption of 14 trivalent lanthanoid ions and yttrium ion (denoted by Ln3+) on calcite surfaces was investigated under various solution conditions of pH (pH = 6.8-7.8) and calcium ion concentration (pCa = -log[Ca2+]= 2.0 and 3.0), and different surface conditions of calcite crystals (well-developed and rough surfaces). The lanthanoid ions were equilibrated in a solution of ionic strength 0.1 mol dm-3(NaCl) saturated with calcite at 25.0 degrees C using excess (solid) calcite crystals suspended in solution. The concentrations of the lanthanoid ions on the calcite crystals (C(cry)/mol kg-1) and in solution (C(soln)/mol dm-3) were determined by means of inductively coupled plasma-mass spectrometry (ICP-MS). It is found that the distribution ratio (D=C(cry)/C(soln) decreases as the atomic number of the lanthanoid increases showing the so called Tetrad Effect. D values increase with increasing pH, whereas they are independent of the calcium ion concentration (i.e., carbonate ion concentration). These results indicate that lanthanoid ions are adsorbed on the calcite surface together with hydroxide ions, i.e., the adsorption of hydroxo-complexes. The heavy lanthanoid ions (Er3+ to Lu3+) are adsorbed as monohydroxo-complexes, (Ln(OH)2+), whereas those of the light lanthanoids are predominantly adsorbed as dihydroxo-complexes (Ln(OH)2+). Other lanthanoids show competitive adsorption reactions of mono- and dihydroxo complexes. Both successive adsorption constants of hydroxo complexes increase with decreasing atomic number of the lanthanoid. The rough surface of calcite is quite active and the distribution ratio of the lanthanoid ions on the rough surface is much higher than that on the well-developed crystalline surface. Rates of adsorption of lanthanide ions were measured and mechanisms are being discussed

A preliminary analysis of the balance between Th1 and Th2 cells after CD34+ cell-selected autologous PBSC transplantation

BACKGROUND

CD34+ cell-selected autologous PBSC transplantation (CD34+ APBSCT) is a procedure used for the treatment of patients with malignant disease that is intended to eliminate residual tumor cells from autologous grafts. However, frequent infectious complications after CD34+ APBSCT can occur. A delay of recovery of the absolute number of CD4+ T cells after transplantation was reported to be one disadvantageous factor. As data on T-cell function after CD34+ APBSCT are scanty, we analyzed changes in T-helper cell 1 (Th1) and T-helper cell 2 (Th2) after CD34+ APBSCT to evaluate immune reconstitution.

METHODS

Twelve patients underwent APBSCT (CD34+APBSCT group, n=4, and unselected APBSCT, n=8). Peripheral blood (PB) samples were obtained at 2, 4, 8, 12 and 16 weeks after the transplantation. The dynamics of the Th1 and Th2 were analyzed at a single-cell level, using flow cytometry.

RESULTS

In the CD34+ APBSCT group, not only the absolute count of CD4+ T cells but also the proportion of Th1 cells in CD4+ T cells and the ratio of Th1 to Th2 after transplantation were significantly decreased at 2 and 4 weeks after transplantation compared with findings in the unselected APBSCT group.

DISCUSSION

We suggest that higher rates of infectious complications after CD34+ APBSCT may be due to the inability of residual T cells from the CD34+ cell selection to generate mature T cells that function adequately against infection. Although further study would be required, our preliminary data provide some information on the immune reconstitution after CD34+ APBSCT and differentiation of T lymphocytes into Th1 and Th2 in vivo.

Influence of the inclination of the plate of an intra-oral tracing device on the condylar position registered by tapping movement

The object of this study was to determine the best inclination of the intra-oral tracing device to get optimum condylar position with the registration of tapping movement. Three appliances with different tracing plate inclinations were used in five healthy subjects. The tracing plates were set at 0 degrees to occlusal plane (horizontal); at the angle formed by drawing a line from condylar point to the stylus position at occlusal plane (inclined); then at the angle half to inclined (half-inclined). Subjects made Gothic arch and tapping movements (n = 30) at a 30 mm interincisal distance with the head Camper plane horizontal. The incisal and condylar points were tracked with a 6-degree-of-freedom jaw movement tracking system. The location of gothic arch apex, the distribution and mean position of 30 tapping points from intercuspal position were analyzed in incisal and condylar point between the appliances. Data were analyzed with repeated measures one-way anova. Results showed that mean position of tapping points were significantly different among the appliances. Half-inclined appliance recorded tapping points in a convergent area nearer to intercuspal position (IP) than other appliances. In all appliances, the contact points of the tapping movement were anterior to Gothic arch apex.

Amyloid A-type renal amyloidosis in a patient with sarcoidosis: report of a case and review of the literature

A 53-year-old man developed chronic renal failure during a protracted course of sarcoidosis. A renal biopsy showed Congo red-positive homogenous deposits in the subendothelial space of glomerular capillary walls and arterial walls. On electron microscopy, amyloid fibrils were observed in the deposits. Immunohistochemistry showed positive staining for amyloid A (AA) protein. Treatment with prednisolone resulted in poor response, followed by progressive deterioration of renal function requiring hemodialysis. To our knowledge, there are 5 cases with histologically proven renal amyloidosis accompanied by sarcoidosis. Prognosis in these patients is extremely poor. AA-type amyloidosis should be considered as a rare renal complication in the setting of long-standing sarcoidosis.

The presence and longevity of peripherally expanded donor-derived TCRalphabeta+ mature T lymphocyte clones after allogeneic bone marrow transplantation for adult myeloid leukemias

There are two major pathways for T-cell regeneration after allogeneic bone marrow transplantation; thymus-dependent T-cell differentiation of T-cell progenitors, and peripheral expansion of mature T cells in the graft. In order to learn to what extent the peripheral expansion of donor-derived mature T lymphocytes contributes to reconstitution of the TCRalphabeta+ T-cell repertoire after allogeneic bone marrow transplantation for adult myeloid leukemias, we pursued the fate of donor-derived T-cell clones using the amino-acid sequences of the complementarity-determining region 3 (CDR3) of the TCR-beta chain as a clonal marker. Clonal expansion of TCRalphabeta+ T lymphocytes with specific TCRBV subfamilies was identified in donor blood. Identical T-cell clones were not found in blood from recipients before transplantation. The donor-derived T-cell clones were identified in the circulating blood from recipients a few months after allogeneic bone marrow transplantation, and they remained in the blood for 18 months after transplant in two recipients, and for 56 months in one. These results suggest that the peripheral expansion of mature T lymphocytes in the graft makes a significant contribution to post-transplant T-cell regeneration during the early period of transplantation in humans, and that mature T cells can survive in recipients for several years. Further investigation will be required to explore which antigens drive the expansion of T-cell clones in donors and recipients, and the mechanisms of maintaining homeostatic balance between the thymus-dependent pathway and the peripheral expansion of mature T cells in post-transplant T-cell regeneration.

Granular lymphocyte proliferative disorder after autologous peripheral blood stem cell transplantation for multiple myeloma

A 57-yr-old woman with multiple myeloma underwent tandem autologous peripheral blood stem cell transplantation (APBSCT). Fever, anemia, and thrombocytopenia, followed by the proliferation of granular lymphocytes in the peripheral blood occurred, after a second APBSCT. Clonal rearrangement of the T-cell receptor was detected using Southern blot analysis of peripheral blood samples. Granular lymphocyte proliferative disorders (GLPD) were diagnosed. After steroid therapy, the symptoms resolved. Lymphocytosis did not recur after the discontinuation of steroids. There have been a few reports of GLPD after solid organ and allogeneic hematopoietic stem cell transplantations. We report a first case of GLPD after APBSCT.

Severe aplastic anemia associated with thymic carcinoma and partial recovery of hematopoiesis after thymectomy

Aplastic anemia has been a rare complication of thymic tumors documented in only a few cases. We now report that a previously healthy, 72-year-old woman had a well-differentiated squamous cell thymic carcinoma and severe aplastic anemia, as detected on a simultaneous basis. After extirpation of the thymic carcinoma, hematological recovery was achieved. While cyclosporine (CyA), prednisolone (PSL), and methenolone improved hematological data even more, a partial and stable remission has been sustained for 22 months. The patient's serum prior to the surgery had a suppressive effect on the formation of colonies of erythroid and nonerythroid colonies, as determined using the patient's bone marrow cells and compared with the patient's serum after the surgery and normal AB serum. This case report concerns a patient in whom we observed simultaneous occurrence of a thymic tumor and a sever marrow aplasia for which we describe our therapeutic approach.

Clinical applications of CD34+ cell-selected peripheral blood stem cells

Peripheral blood stem cells (PBSC) are increasingly used for stem cell transplantation after high dose chemotherapy. CD34+ cell selection has also been done for use in autologous transplantation studies Bone marrow (BM) may contain tumor cells at the time of harvesting, and on re-infusion, these cells could contribute to a subsequent relapse. Similarly, tumor cell contamination of PBSC collections has been found in a number of studies. Therefore, purging contaminating tumor cells may prevent cases of relapse. As most tumor cell types do not express CD34 antigen, one of the most widespread applications of CD34+ cell selection is likely to be in tumor cell purging. Similarly, CD34+ cell selection has aided allogeneic transplantation studies. Acute graft-versus-host disease (aGVHD) is a major cause of morbidity and mortality in cases of allogeneic transplantation. As aGVHD is mediated by donor T cells, removal of T cells from the graft by CD34+ cell selection may ensure prophylaxis against aGVHD. Further, high-dose immunosuppression followed by CD34+ cell-selected stem cell rescue is theoretically reasonable as a therapeutic tool for patients with autoimmune disease resistant to conventional therapy. However, patients given T cell-depleted transplantation have an increased risk of opportunistic infection as well as malignancies related to immunosuppression; therefore, close monitoring is warranted. We describe here clinical applications of CD34+ cell-selected PBSC for a variety of diseases, with special emphasis on the efficacy as well as drawbacks of this novel technique.