Prediction of effect of interferon on chronic hepatitis C

Clinical, pathological, and virological analysis including hypervariable region-1 of hepatitis C virus (HCV) was performed to predict the effect of interferon (IFN) on 41 patients with chronic hepatitis type C. The low virus load, low frequency of the mutation in the hypervariable region-1 as the change of amino acid and high level of serum aminotransferase make one estimate the good effect of IFN on patients with HCV. Mutation in the hypervariable region-1 of HCV measured by fast assay fluorescence single-stranded conformational polymorphism was more frequent in nonresponders to IFN than responders. The most frequently mutated position was amino acid number 406. This indicates that the specific mutation site might affect the response of IFN.

Induction of subcutaneous tissue fibrosis in newborn mice by transforming growth factor beta-simultaneous application with basic fibroblast growth factor causes persistent fibrosis

To establish an appropriate animal model of skin fibrosis by exogenous application of growth factors, we investigated the in vivo effects of transforming growth factor-beta by injection into subcutaneous tissue of newborn mice. Histological examination revealed that TGF-beta1, beta2, and beta3 induced granulation tissue formation after 3 days of injection, while these changes had disappeared after 7 days. The changes after 3 days of injection were more pronounced in the tissue injected with TGF-beta2 or beta3 than that with TGF-beta1. In situ hybridization analysis indicated that connective tissue growth factor mRNA was strongly expressed in the fibroblasts at the site of TGF-beta injection, which suggested that fibroblasts were activated by TGF-beta. Next, we investigated the cooperative effects of TGF-beta and other growth factors including basic fibroblast growth factor (bFGF). The simultaneous application of TGF-beta and bFGF caused apparent tissue fibrosis which persisted for at least 2 weeks, while bFGF alone caused slight fibrotic changes after 7 days of injection. Thus, we succeeded in establishing an animal model of skin fibrotic disorders by the exogenous addition of growth factors, and this animal model will be useful for future studies in this area.

Immunohistochemical analysis of platelet-derived growth factor and its receptors in fibrohistiocytic tumors

Platelet-derived growth factor (PDGF) is known to stimulate the proliferation of fibroblasts, although the role of PDGF and its receptors in the development of fibrohistiocytic tumors has not been clarified. In this study, we investigated this role by immunohistochemically staining PDGF and PDGF beta-receptors in paraffin-embedded dermatofibroma (DF), dermatofibrosarcoma protuberans (DFSP) and malignant fibrous histiocytoma (MFH) tissue. We also immunohistochemically investigated the relationship between PDGF beta-receptors and CD34, which is a known immunohistochemical marker for DFSP. Immunohistochemical studies using anti-PDGF-AA or BB antibodies showed that PDGF-AA and BB was found in 20 to 40% of the tumor cells in DF, DFSP, and MFH. No definite relationship for each tumor type was found. The expression of PDGF beta-receptors in DFSP and that of MFH tissue was significantly greater in comparison to DF and scar tissue. The expression of CD34 and PDGF beta-receptors in DFSP was observed in identical areas. These findings suggest that autocrine or paracrine growth stimulation, through PDGF beta-receptors, is related to the tumorous proliferation of fibrohistiocytic tumors, and the expression of PDGF beta-receptors might play a role in the proliferation of CD34 positive tumor cells.

Simultaneous measurement of serum 5-S-cysteinyldopa, circulating intercellular adhesion molecule-1 and soluble interleukin-2 receptor levels in Japanese patients with malignant melanoma

Serum 5-S-cysteinyl dopa (5-S-CD), circulating intercellular adhesion molecule-1 (cICAM-1) and soluble interleukin-2 receptor (sIL-2R) have each been reported as useful markers for melanoma progression. To assess the clinical relevance of these three markers, we simultaneously assayed their serum levels in 30 Japanese melanoma patients. Pre-surgical serum levels of 5-S-CD, cICAM-1 and sIL-2R were elevated in six, 13 and five patients respectively. These abnormal values returned to normal after curative surgery in most of the patients, suggesting a direct relationship to the presence of the primary tumour. Pre-surgical values of these three markers, either individually or in combination, did not predict the development of subsequent metastases. The sequential measurements of the three markers in eight patients who had relapse after surgery showed that serum 5-S-CD is the most useful marker for disease progression, although it is dependent on the melanin-producing ability of individual recurrent tumours. sIL-2R seemed to reflect in vivo activation of the host immune system and was a good indicator for predicting occult metastasis in selected cases. Circulating ICAM-1 levels were less relevant to the clinical disease course in our cases, although they tended to increase strikingly after liver metastasis. Our results in this limited number of cases show that the significance of the three markers varied with the individual and suggest that the simultaneous measurement of these markers may facilitate the early detection of metastases and proper therapeutic intervention.

Impaired healing of gastric lesions in streptozotocin-induced diabetic rats: effect of basic fibroblast growth factor

We examined the influence of diabetes on the healing of HCI-induced gastric lesions and the healing promoting effect of basic fibroblast growth factor (bFGF) on these lesions under diabetic conditions induced in rats by streptozotocin (70 mg/kg, i.p.). The experiments were performed using 2-wk streptozocin-diabetic rats with blood glucose levels of >300 mg/dl. After 18 hr fasting, these animals were given 1 ml of 0.6 N HCl by gavage, and 1 hr later they were fed normally before being killed on various days after HCI treatment. Recombinant human basic fibroblast growth factor (acid resistant recombinant human basic fibroblast growth factor mutein CS-23: 10 to 1000 ng/kg x 2, p.o.) or insulin (4 U/rat x 1, s.c.) was given 5 days after HCl treatment. Gastric lesions induced by HCI healed to quiescent state within 5 days both macro- and microscopically. Diabetic conditions did not affect the development of HCI-induced gastric lesions but significantly delayed the healing of these lesions. Daily administration of insulin returned high blood glucose levels to within normal ranges (120-140 mg/dl) and significantly antagonized the delayed healing of these lesions. The delayed healing in diabetic rats was also significantly promoted by recombinant human basic fibroblast growth factor (>300 ng/kg x 2) without any effect on blood glucose level. In normal rats, the mucosal levels of bFGF increased significantly in response to gastric injury at 3 days after HCI treatment. The mucosal bFGF levels in streptozotocin-diabetic rats were significantly lower under basal conditions before HCI treatment and did not increase after injury, yet such dysregulation of bFGF production was partially restored by insulin treatment. rhbFGF even at 1000 ng/kg had no effect on gastric acid secretion in either normal or streptozotocin-diabetic rats. These results suggest that diabetic conditions have deleterious influences on the healing of acute gastric lesions in both an insulin- and bFGF-sensitive manner, and that the administration of exogenous bFGF antagonizes the delayed healing of gastric lesions observed in diabetic animals.

Elevated serum tumor necrosis factor-alpha levels in patients with systemic sclerosis: association with pulmonary fibrosis

OBJECTIVE

To determine whether serum tumor necrosis factor-alpha (TNF-alpha) levels are elevated, and whether they correlate with clinical features in patients with systemic sclerosis (SSc).

METHODS

Serum samples from patients with limited cutaneous SSc (ISSc) (n = 51), diffuse cutaneous SSc (dSSc) (n = 30), and control subjects (n = 30) were examined by ELISA.

RESULTS

Serum TNF-alpha levels were elevated in patients with ISSc and dSSc and correlated with the presence of pulmonary fibrosis and with the decreased vital capacity of the patients.

CONCLUSION

Serum TNF-alpha may be one of the cytokines that contribute to the disease process, especially to pulmonary fibrosis in patients with SSc.

The effect of the flow of air on horizontal transmission of Salmonella enteritidis in chickens

Horizontal transmission of Salmonella enteritidis and the effect of airflow on spreading were examined in 80 5-wk-old chickens divided into five groups. Sixteen chickens in each group were placed in four cages in a row separated by wire. One among four chickens placed in a cage at the downwind end of the row was inoculated orally with 10(9) colony-forming units of S. enteritidis. Cecal droppings, drinking water, and feed were cultured every day. Horizontal transmission was rapid in the row with low air velocity but slow in the row with high air velocity. However, in another experiment, where the inoculated chicken was situated in a cage upstream in the airflow, horizontal transmission was equally rapid whether the airflow was rapid or slow. Contamination of feed and water never preceded the appearance of positive cecal droppings. These findings suggest that the rapidity of horizontal transmission of S. enteritidis may be affected by airflow patterns.

PACAPs stimulate duodenal bicarbonate secretion at PACAP receptors in the rat

We investigated the effects of pituitary adenylate cyclase-activating polypeptides (PACAPs) on gastroduodenal HCO(3)- secretion in anesthetized rats and characterized their effects by comparison with the effects of vasoactive intestinal polypeptide (VIP). Under urethan anesthesia, a rat proximal duodenal loop or a rat stomach mounted in an ex vivo chamber (in the absence of acid secretion) was perfused with saline, and HCO(3)- secretion was measured at pH 7.0 using a pH-stat method and by addition of 10 mM HCl. Intravenous injection of PACAP-27 stimulated HCO(3)- secretion in a dose-dependent manner in the duodenum, but not in the stomach, although this peptide had no effect on duodenal HCO(3)- secretion after intracisternal administration. The duodenal HCO(3)- stimulatory action was similarly observed after intravenous administration of PACAP-38 and VIP, and the potency of action was in the following order: PACAP-27 > PACAP-38 = VIP. The duodenal HCO(3)- stimulatory action of PACAP-27 was potentiated by pretreatment with 3-isobutyl-1-methylxanthine, similar to that of prostaglandin E2, and was significantly attenuated by PACAP-(6--27) (PACAP antagonist) or Ac-Tyr1,D-Phe2-VIP (VIP antagonist) but was not affected by bilateral vagotomy or prior administration of atropine, verapamil, and indomethacin. Forskolin, the stimulator of adenylate cyclase, also increased HCO(3)- secretion in the duodenum, but not in the stomach. These results suggest that 1) PACAP is a potent stimulator of HCO(3)- secretion in the duodenum, but not in the stomach, and may be involved in the peripheral regulation of duodenal HCO(3)- secretion, 2) this action is mediated by adenosine 3',5'-cyclic monophosphate, probably through PACAP and VIP receptors, and 3) adenosine 3',5'-cyclic monophosphate is a mediator in duodenal, but not in gastric, HCO(3)- secretion.

Nonscarring inflammatory epidermolysis bullosa acquisita with esophageal involvement and linear IgG deposits

A 24-year-old woman with autoimmune thrombocytopenia and hypothyroidism had an inflammatory bullous eruption in the mouth, face, and trunk that left no milia or scars after healing. Histologic examination revealed a subepidermal bulla and a neutrophil infiltration. Direct immunofluorescence examination showed deposition of IgG and C3 in the basement membrane zone (BMZ). Indirect immunofluorescence examination with 1M sodium chloride-split skin showed IgG binding to the dermal side. Immunoblot analysis demonstrated IgG autoantibodies reacting with 290 kD dermal protein. We diagnosed this as epidermolysis bullosa acquisita (EBA) with a nonscarring inflammatory feature. Treatment with oral dapsone, 75 mg, and prednisolone, 20 mg, cleared the eruption. Reduction of the prednisolone dosage was associated with multiple erosions in the esophagus. Direct immunofluorescence examination revealed linear deposition of IgG in the esophageal BMZ. To our knowledge, this is the first report of EBA with esophageal involvement and deposition of IgG in the BMZ of the esophagus.

Alterations in duodenal bicarbonate secretion and mucosal susceptibility to acid in diabetic rats

BACKGROUND & AIMS

The gastroduodenal mucosal susceptibility to ulcerogenic stimuli increases in diabetic conditions, but the mechanism is unknown. The aim of this study was to investigate alterations in duodenal HCO3- secretory response in diabetic animals.

METHODS

The experiments were performed in rats treated with streptozotocin (70 mg/kg intraperitoneally) after 1-6 weeks of diabetes, when blood glucose levels were > 300 mg/dL. HCO3 secretion was measured in the proximal duodenal loop of rats that were under urethane anesthesia using a pH-stat method.

RESULTS

The duodenal HCO3 secretion induced by mucosal acidification was decreased in streptozotocin-treated rats depending on the duration of diabetes. The HCO3 secretion was also decreased in response to 16,16-dimethyl prostaglandin E2, vasoactive intestinal polypeptide, or vagal electrical stimulation. Acid load in the duodenum produced extensive damage in 5-6-week diabetic rats, although the same treatment caused only slight damage in the normal rat duodenum. Such alterations in the duodenal HCO3 secretory and ulcerogenic responses in diabetic rats were partially restored by daily injection of insulin.

CONCLUSIONS

The results suggest that streptozotocin-diabetic conditions impair the duodenal HCO3- secretion in rats, possibly as a result of decreased sensitivity of the epithelial cell and dysfunction of neuronal pathway, thereby increasing the mucosal susceptibility to acid injury in the duodenum.

Elevated serum levels of interleukin 4 (IL-4), IL-10, and IL-13 in patients with systemic sclerosis

OBJECTIVE

To determine whether serum interleukin 4 (IL-4), IL-10, and IL-13 levels in patients with systemic sclerosis (SSc) are elevated and whether they correlate with the clinical or serologic features of this disease.

METHODS

Serum samples from patients with limited cutaneous SSc (ISSc) (n = 45), diffuse cutaneous SSc (dSSc) (n = 28), and control subjects (n = 30) were examined by ELISA.

RESULTS

Serum IL-4 and IL-13 levels were significantly higher in patients with ISSc and dSSc than in the controls. Serum IL-10 levels were significantly higher in the patients with dSSc compared with controls. Elevated IL-10 levels were detected frequently in patients with arthralgia. Serum IL-13 levels correlated with erythrocyte sedimentation rates and C-reactive protein levels in patients.

CONCLUSION

We suggest that IL-4, IL-10, and IL-13 may be some of the cytokines that contribute to the disease process, and that IL-13 may be a serologic indicator of systemic inflammation in patients with SSc.

Tape stripping induces marked epidermal proliferation and altered TGF-alpha expression in non-lesional psoriatic skin

Psoriasis is a chronic inflammatory disorder characterized by epidermal hyperproliferation. Although recent evidence suggests that T cell activation is a primary trigger for psoriasis lesions, there may be alterations in the keratinocyte growth regulatory pathways which induce epidermal hyperproliferation in psoriatic patients. To test this hypothesis, we investigated the proliferative activity of epidermal keratinocytes 48 h after tape stripping, one of the standard mechanical ways to stimulate the epidermis, in 20 psoriasis patients and in 18 controls. Epidermal cell kinetics were assessed with DNA flow cytometry, the mitotic index, bromodeoxyuridine incorporation, Ki-67 antigen expression and DNA polymerase alpha expression. The expression of TGF-alpha and EGF receptors, critical mediators of keratinocyte proliferation, were also investigated immunohistochemically. The results of multiparameter assays showed that the baseline proliferative activity in uninvolved skin was the same in psoriasis patients and normal controls. After tape stripping, although both psoriasis patients and the normal controls showed significant increases in epidermal cell proliferation, the values of all the parameters investigated were significantly greater in the psoriasis patients than in the normal controls. EGF receptors were overexpressed in basal and suprabasal keratinocytes after tape stripping in both the psoriasis patients and the normal controls. In contrast, overexpression of TGF-alpha was only observed in the patients with psoriasis, which may explain their increased proliferative response to trauma.

Failure of the nitric oxide synthase inhibitor to stimulate duodenal bicarbonate secretion in streptozotocin-diabetic rats

We examined the HCO(3)- stimulatory effects of L-NAME (N(G)-nitro-L-arginine methyl ester) in the proximal duodenum of streptozotocin (STZ)-induced diabetic rats and compared with those of 16,16-dimethyl prostaglandin E2 (dmPGE2) and vagal electrical stimulation. Male SD rats were given STZ (70 mg/kg) i.p., and the experiments were done using 1 approximately 6 week STZ-diabetic rats with blood glucose levels of >300 mg/dl. Under urethane anesthesia the HCO(3)- secretion was measured in the proximal duodenal loop using a pH-stat method and by adding 10 mM HCl. Hyperglycemic conditions appeared 1 week after STZ treatment and remained during 6 week-test period. The duodenal HCO(3)- secretory response to L-NAME was significantly decreased in STZ-diabetic rats; the degree of reduction was dependent on the duration of diabetes, and the stimulatory effect disappeared completely in rats after 5 approximately 6 weeks of diabetes. Intravenous administration of L-NAME markedly increased arterial blood pressure with significant decrease in heart rate in normal rats, whereas in STZ-diabetic rats this agent caused only pressor response without any effect on heart rate. STZ-diabetic rats also secreted significantly less amount of HCO(3)- from the duodenum in response to dmPGE2 and vagal electrical stimulation after 5 approximately 6 weeks of diabetes. These all changes observed in STZ-diabetic rats were significantly reversed by daily injection of insulin. These results suggest that 1) L-NAME failed to stimulate duodenal HCO(3)- secretion in STZ-diabetic rats, and 2) impairment of the duodenal HCO(3)- secretory ability in STZ-diabetic conditions is due to both vagal-dependent neuronal dysfunction and decreased sensitivity of the secreting cell.

Role of nitric oxide in mucosal blood flow response and the healing of HCl-induced lesions in the rat stomach

The role of nitric oxide (NO) in the gastric mucosal blood flow response and the healing of HCl-induced gastric lesions was investigated in rats. After 18 h fasting rats were given 0.6 N HCl p.o. for the induction of gastric lesions, and 1 h later they were fed normally. After induction of gastric lesions, they were repeatedly administered the NO synthase inhibitors NG-nitro-L-arginine methyl ester (L-NAME 5-20 mg/kg p.o. twice daily) or aminoguanidine (20 mg/kg s.c. once daily) for 7 days. Gastric lesions caused by HCl healed almost completely within 5 days with granulation and to an extent with re-epithelialization. Repeated administration of L-NAME but not aminoguanidine significantly delayed the healing of gastric lesions in a dose-dependent manner. The damaged mucosa secreted less acid, but showed a marked rise in H+ permeability, resulting in luminal acid loss accompanied by an increase of mucosal blood flow. Aminoguanidine did not significantly affect any of these functional changes observed in the stomach after damage by HCl, whereas L-NAME treatment slightly reversed the decreased acid response, increased the luminal H+ loss, and totally inhibited the mucosal hyperemic response associated with luminal acid loss in the damaged mucosa. In addition, the deleterious influences of L-NAME on the mucosal blood flow response and the healing of gastric lesions were significantly antagonized by co-administration of L-arginine but not of D-arginine (500 mg/kg x 2, i.p.). Luminal output of NO2-/NO3- was significantly increased in pylorus-ligated stomachs in control rats on days 3 and 5 after damage, and such increases in gastric NO output were completely attenuated by L-NAME treatment. These results suggest that endogenous NO may contribute to the healing of acute gastric injury by mediating the mucosal hyperemic responses associated with acid back-diffusion and by facilitating acid disposal in the damaged mucosa. NO mediating such responses and participating in the healing aspect of gastric lesions may be produced by the constitutive type of NO synthase.

Tumour cells of extramammary Paget's disease do not show either p53 mutation or allelic loss at several selected loci implicated in other cancers

Extramammary Paget's disease is a particular form of skin cancer of unknown histogenesis. To look for the genetic defects underlying the pathogenesis of this tumour, we have examined loss of heterozygosity (LOH), p53 and human papillomavirus (HPV) status, and the expression of c-erbB-2 and bcl-2 proteins in 14 cases. Unexpectedly, no LOH was detected at several loci commonly lost in other human cancers (namely 3p, 9p, 9q, 13q, 16q, 17p, and 17q) in 12 tumours examined. Altered p53 protein expression was entirely or mostly negative in all 14 cases. Direct sequencing of exons 5-8 of the p53 gene in eight cases revealed no mutation. Polymerase chain reaction amplification of the L1 gene of human papillomavirus (HPV) did not detect the virus that could inactivate p53 and retinoblastoma tumour-suppressor gene products. As expected, c-erbB-2 proto-oncogene protein was overexpressed in six cases. The expression of bcl-2 was negative in all cases. The results presented in this study suggest that molecular events underlying extramammary Paget's disease differ from those of other common epithelial malignancies and that tumour-suppressor genes located in chromosome regions not examined in this study may be important.

Changes in gastric HCO-3 secretory response to NG-nitro-L-arginine methyl ester in rats following repeated administration

The effect of repeated administration of the nitric oxide synthase inhibitor NG-nitro-L-arginine methyl ester (L-NAME) on gastric HCO-3 secretion was examined using ex vivo chambered stomachs of anaesthetized rats. Intravenous administration of L-NAME (5 mg/kg) increased gastric HCO-3 secretion with a concomitant rise in arterial blood pressure (BP). The HCO-3 stimulatory action of L-NAME diminished when rats were pretreated with L-NAME (20 mg/kg, p.o., twice daily) for 1 or 3 days and an inverse relationship was found between the degree of secretory stimulation and the period of pretreatment. The increased BP response to L-NAME was also significantly lessened following repeated pretreatment; basal BP showed a stepwise increase during repeated pretreatment and did not change at all in response to i.v. L-NAME after 3 days pretreatment. When delta HCO-3 output induced by i.v. L-NAME was plotted against delta BP (from basal values) during repeated pretreatment with L-NAME, a significant relationship was found between these two factors. The reduction in the HCO3 secretory response to L-NAME was restored when animals were pretreated with L-arginine (500 mg/kg, i.p., twice daily) together with L-NAME. However, prostaglandin E2 (300 micrograms/kg, i.v.) caused a gastric HCO-3 secretory response similar to L-NAME, regardless of whether rats had been pretreated with L-NAME or not. In contrast, the attenuation by L-NAME of the acid (0.2 nmol/L HCl)-induced gastric hyperaemic response was not influenced by repeated pretreatment with L-NAME. We conclude that repeated p.o. pretreatment with L-NAME reduces the HCO-3 stimulatory action of i.v. L-NAME and that this phenomenon may be explained by the lack of further elevation of BP in response to i.v. L-NAME following repeated pretreatment with this agent. Thus, the stimulation of HCO-3 secretion by i.v. L-NAME may be causally related with increased BP in response to this agent.

[Local immune responses in uterine cervical carcinogenesis]

In order to investigate the role of local immune response in uterine cervical carcinogenesis, lymphocyte phenotypes infiltrating the cervical region were studied by indirect immunoperoxidase staining for natural killer (NK) cells, macrophages. Langerhans cells (LC), memory T cells, CD4-positive cells and CD8-positive cells. The specimens used in this study were 9 normal ectocervical epithelium samples, 28 with mild dysplasia, 28 with moderate dysplasia, 31 with severe dysplasia and 9 with carcinoma in situ (CIS). A quantitative study was conducted in 23 patients with persistent cervical dysplasia and a comparable control group of 17 patients with regressive dysplasia. Human papillomavirus (HPV) types 16 and 18 DNA was analyzed by using polymerase chain reaction techniques, and differences in local immune responses between cases with and others without HPV types 16 and 18 were studied. The results are as follows. 1) The numbers, of NK cells and macrophages increased as the grade of cervical dysplasia increased and the numbers of these cells in cases of cervical dysplasia were greater than in normal ectocervical epithelium and CIS. 2) The numbers of LC, memory T cells and CD4-positive cells also increased with the grade of cervical dysplasia. The number of memory T cells was significantly greater in severe cervical dysplasia than in normal ectocervical epithelium or mild dysplasia (p < 0.05). 3) There were statistically significant correlations between the number of white blood cells and those of stroma-infiltrating memory T cells (r = 0.98) and CD4-positive cells (r = 0.88). A positive correlation was found between the numbers of lymphocytes in epithelium and in subepithelium. 4) A significant reduction in CD4-positive cells was founded in persistent dysplasia compared with regressive dysplasia (p < 0.05). 5) Cases with and without HPV types 16 and 18 did not differ significantly with respect to local immune responses. It is therefore considered that the increased number of lymphocytes in cervical dysplasia and the decreased number in CIS might reflect active local immunosurveillance in the process of carcinogenesis. Lymphocytes, especially CD4-positive cells, may play an important role in surveillance against the development and progression of cervical cancer.

Epidemiological analysis of prognosis of 496 Japanese patients with progressive systemic sclerosis (SSc). Scleroderma Research Committee Japan

For the first time, we performed an epidemiological study of SSc in Japan to study the factors influencing prognosis, survival rate and cause of death of Japanese SSc patients and to compare our data with those from foreign countries. Prognosis of 496 Japanese patients with progressive systemic sclerosis (SSc) was analyzed based on clinical data described in case cards provided by the members of the Scleroderma Research Committee of the Japanese Ministry of Health and Welfare. The essential observation period was from 5 to 20 years, at ending in 1994. Ninety patients died (males 11, females 79). The age of onset of the deceased patients was significantly higher than that of surviving patients (deceased, 45.6 yrs, surviving 41.3 yrs). Statistically significant factors for a poor prognosis were as follows: Barnett type III > type II > type I, positive for anti-Scl-70 antibody, negative for anti-centromere antibody. The survival rate at 5 years after the onset of the disease was 0.937, followed by 0.82 at 10 years, 0.567 at 20 years and 0.40 at 30 years after the onset. Sex was not a predictor for prognosis, although male patients died at an earlier stage of the disease. The most common causes of death were heart failure, pulmonary insufficiency, lung fibrosis, and renal failure. Twenty-four patients had cancer of which 13 were lung cancers. The current status of the survival rate and prognostic factors of 496 Japanese SSc patients is summarized. In future, more well-controlled studies using the same criteria should be performed for the better understanding and management of SSc.

Hepatocellular carcinoma with pleural metastasis complicated by hemothorax

Hemothorax can be caused by rupture of hepatocellular carcinoma (HCC). Hemoperitoneum is a well-known cause of death caused by rupture of a primary HCC lesion. Rupture of a HCC metastasis has not been adequately described. This is the first report of a HCC patient who died of hemothorax due to rupture of a pleural metastasis. The patient, a woman, died in respiratory failure 2 wk after rupture of her HCC metastasis in the pleura. Autopsy revealed moderately differentiated HCC in the liver, lung, and pleura. We discuss treatment options for ruptured pleura-based HCC metastases.

Measurement of anticardiolipin antibodies by ELISA using beta 2-glycoprotein I (beta 2-GPI) in systemic sclerosis

In order to determine the prevalence and clinical significance of beta 2-GPI-dependent anticardiolipin antibodies (beta 2-GPI/aCL) in patients with systemic sclerosis (SSc), serum samples from 80 patients with SSc, 20 patients with systemic lupus erythematosus (SLE), and 120 healthy control subjects were examined by ELISA using purified beta 2-GPI. IgG isotype beta 2-GPI/aCL was present in eight of 80 patients with SSc (10%), and the presence of beta 2-GPI/aCL IgG was significantly correlated with the presence of isolated pulmonary hypertension (PH). Furthermore, levels of beta 2-GPI/aCL IgG were significantly correlated with levels of mean pulmonary arterial pressure. These data suggest that IgG isotype beta 2-GPI/aCL might be a serological indicator of the severity of PH in patients with SSc.

Intrapituitary distribution and effects of annexin 5 on prolactin release

Annexin 5 is expressed by rat anterior pituitary cells and a depolarizing stimulus results in increased extracellular display and, depending on local calcium concentrations, potential release into the extracellular environment. In order to further investigate the role of annexin 5 in anterior pituitary function, we have examined the intracellular distribution by immunocytochemistry and the effects of annexin 5 on the release of a major secretory product, prolactin. Prolactin was chosen because we could easily monitor effects on basal release and effects on the immediate and sustained phases of thyroid stimulating hormone releasing hormone (TRH)-stimulated release. Immunocytochemical localization of annexin 5 showed staining of the majority of anterior pituitary cells. Labeling was predominantly on the nuclear envelope and plasma membrane. For the chosen secretory product, prolactin, annexin 5 was found in most, but not all prolactin positive cells. When recombinant annexin 5 (50 ng/mL) was added to a 3 h static culture incubation of rat anterior pituitary cells, prolactin release was inhibited by about 30% (p<0.05). A lower dose had a reduced effect and higher doses had no further inhibitory effect, indicating that the effect was specific to annexin 5 and not a nonspecific toxic effect of some contaminant in the preparation. This interpretation was further strengthened in a time-course experiment demonstrating that when TRH and annexin 5 were added together, there was no effect of annexin 5 on the amount of prolactin released. After a 3 h preincubation in annexin 5, however, prolactin release, in response to TRH, was suppressed by about 30% in both the acute and sustained phases. These data suggest that annexin 5 may be a local regulator of release in the anterior pituitary, but a slow onset effect on both phases of TRH-stimulated release suggests that this is not an effect at the plasma membrane such as local extracellular calcium depletion by plasma membrane-bound annexin 5.

Widespread pruritic plaques in a patient with subacute cutaneous lupus erythematosus and hypocomplementemia: response to dapsone therapy

We describe a patient with subacute cutaneous lupus erythematosus, widespread pruritic papulosquamous plaques, and hypocomplementemia. Skin biopsy specimens revealed liquefaction degeneration and colloid bodies and dyskeratotic cells in basal and suprabasal layers. An immunofluorescence study revealed deposits of IgG, IgM, and C3 at the dermalepidermal junction in a bandlike pattern, and particulate IgG deposition in the basal and suprabasal layers. Treatment with prednisolone (15 mg/day), chloroquine phosphate (200 mg/ day), cyclosporine (5 mg/kg daily), and gold (10 mg/day) failed to reduce pruritic plaque formation, and pulse methylprednisolone therapy led to only a transient remission. Clinical exacerbations correlated with a decrease in complement levels. The disease was successfully controlled with dapsone (75 mg/day) and prednisolone (25 mg/day).

Antiubiquitin antibody in localised and systemic scleroderma

OBJECTIVE

To determine the presence of antiubiquitin antibody (AUbA) in localised scleroderma and systemic sclerosis, as it is frequently found in the sera of patients with systemic lupus erythematosus (SLE) and has also been shown to have a close relationship with antihistone antibodies that have an important role in scleroderma.

METHODS

Serum samples from patients with localised scleroderma (n = 48) and systemic sclerosis (n = 52) were examined by enzyme linked immunosorbent assay. Twenty samples from patients with SLE, 20 from patients with dermatomyositis, and 30 samples from healthy individuals were used as controls.

RESULTS

AUbA was demonstrated in 44% of patients with localised scleroderma and in 42% of those with systemic sclerosis. The presence of AUbA correlated with the presence of antihistone antibodies in both localised scleroderma and systemic sclerosis.

CONCLUSIONS

AUbA is frequently present in patients with localised scleroderma and systemic sclerosis. Induction of AUbA is closely associated with that of antihistone antibodies, suggesting that ubiquitinated histone may be the target in autoimmune responses of these disorders.

Detection of Goose parvovirus genome by polymerase chain reaction: distribution of Goose parvovirus in Muscovy ducklings

A portion of the Goose parvovirus (GPV) genome DNA was cloned, sequenced, and primers for polymerase chain reaction (PCR) were prepared. The specificity of the clone was checked by Southern blot hybridization to GPV genome and by in situ hybridization with GPV infected cells. In Muscovy ducklings experimentally infected with the virulent GPV strain IH, the viral genome was detected by PCR on and after 2 days in many tissues including the brain. Using PCR, the primers also detected another GPV strain Ma isolated in Japan.

Soluble CD4 and CD8 in serum from patients with localized scleroderma

Localized scleroderma has been shown to be accompanied by various immunologic abnormalities. To obtain functional information on activated CD4+ or CD8+ T cells, we studied the levels of soluble CD4 (sCD4) and soluble CD8 (sCD8) in serum from patients with localized scleroderma. Serum samples were examined by enzyme-linked immunosorbent assay. The samples were obtained from 49 patients in the following three subgroups: 15 patients with generalized morphea, 22 with linear scleroderma, and 12 with morphea. The levels of sCD4 and sCD8 were significantly elevated in patients with generalized morphea. Furthermore, these patients showed significantly higher levels of sCD4 than those with systemic sclerosis (SSc). The frequency of positivity for IgG anti-single-stranded DNA (ssDNA) antibody was significantly higher in localized scleroderma patients with elevated sCD4 levels than in patients with normal sCD4 levels. The frequency of positivity for antinuclear antibodies, IgM antihistone antibodies, IgG anti-ssDNA antibody and rheumatoid factor, and elevated sCD23 levels were significantly higher in localized scleroderma patients with elevated sCD8 levels than in patients with normal sCD8 levels. Our findings suggest that both CD4+ and CD8+ T cells are activated in vivo in generalized morphea and that the immunologic events in generalized morphea are different from those in SSc.

Clinical significance of serum levels of soluble interleukin-2 receptor in patients with localized scleroderma

Localized scleroderma has been reported to be accompanied by abnormal immune reactions, including autoantibody production and lymphocyte activation. Lymphocyte activation can be quantitatively detected by measuring soluble interleukin-2 receptor (sIL-2R) in serum samples. In this study, serum sIL-2R levels were assayed by a sensitive enzyme-linked immunosorbent assay, in 48 patients with localized scleroderma, in 20 with systemic sclerosis (SSc) and in 20 healthy controls. Serum levels of sIL-2R were significantly higher in patients with localized scleroderma than in healthy controls. The serum levels of sIL-2R were correlated with the number of sclerotic lesions, the number of involved areas, the levels of anti-ssDNA, and the levels of antihistone antibody immunoglobulin M. Moreover, sIL-2R levels in sera from patients with SSc were also significantly higher than in healthy controls. Elevated serum levels of sIL-2R in localized scleroderma suggest that lymphocyte activation is one of the early processes in the development of this disease.

Connective tissue growth factor gene expression in tissue sections from localized scleroderma, keloid, and other fibrotic skin disorders

Connective tissue growth factor (CTGF) is a novel peptide that exhibits platelet-derived growth factor-like activities and is produced by skin fibroblasts after activation with transforming growth factor-beta. Coordinate expression of transforming growth factor-beta followed by CTGF during wound repair suggests a cascade process for control of tissue regeneration. We recently reported a significant correlation between CTGF mRNA expression and histologic sclerosis in systemic sclerosis. To confirm the relation between CTGF and skin fibrosis, we investigated CTGF gene expression in tissue expression in tissue sections from patients with localized scleroderma, keloid, other sclerotic skin disorders using nonradioactive in situ hybridization. In localized scleroderma, the fibroblasts with positive signals for CTGF mRNA were scattered throughout the sclerotic lesions with no preferential distribution around the inflammatory cells or perivascular regions, whereas the adjacent nonaffected dermis was negative for CTGF mRNA. In keloid tissue, the fibroblasts positive for CTGF mRNA were diffusely distributed, especially in the peripheral expanding lesions. In scar tissue, however, the fibroblasts in the fibrotic lesions showed partially positive signals for CTGF mRNA. In eosinophilic fasciitis, nodular fasciitis, and Dupuytren's contracture, CTGF mRNA was also expressed partially in the fibroblasts of the fibrotic lesions. Our findings reinforce a correlation between CTGF gene expression and skin sclerosis and support the hypothesis that transforming growth factor-beta plays an important role in the pathogenesis of fibrosis, as it is the only inducer for CTGF identified to date.

Thrombocytopenia associated with hepatitis C viral infection

BACKGROUND/AIMS

We investigated whether chronic hepatitis C infection is associated with thrombocytopenia.

METHODS/RESULTS

Thrombocytopenia (<15 x 10(4) platelets/mu l) was diagnosed in 151 of 368 patients (41.0%) with chronic hepatitis C, a significantly higher proportion than that observed in patients with chronic hepatitis B (18.9%, p < 0.01). Elevated titers of platelet-associated immunoglobulin G were observed in 88.1% of patients with chronic hepatitis C and in 47.1% of patients with chronic hepatitis B. Platelet-associated immunoglobulin G titers were significantly higher in patients with chronic hepatitis C (87.3 +/- 10.1 ng/10(7) cells) vs. those with chronic hepatitis B (30.3 +/- 6.4) or the control subjects (p < 0.01). There was a significant negative correlation between platelet-associated immunoglobulin G titers and platelet counts in both chronic hepatitis C and B cases. Platelet-associated immunoglobulin G titers were significantly higher in patients with type C cirrhosis than in those with type B cirrhosis. Interestingly, HCV-RNA was detected by RT-PCR in the platelets from 11 of 14 patients with hepatitis C virus.

CONCLUSIONS

These data indicate that chronic infection with hepatitis C virus may produce a significant autoimmune reaction to platelets, leading to thrombocytopenia.

Elevated soluble CD23 levels in the sera from patients with localized scleroderma

Soluble CD23 (sCD23) is closely related to B-cell activation and elevated serum levels of sCD23 have been reported in several autoimmune disorders. This study investigated the serum levels of sCD23 and determined the correlation of sCD23 with other immunologic abnormalities and clinical features in localized scleroderma. We examined 49 serum samples by an enzyme-linked immunosorbent assay in the following three subgroups: 15 patients with generalized morphoea, 22 with linear scleroderma, and 12 with morphoea. The serum levels of sCD23 were significantly elevated in patients with localized scleroderma, compared with those in healthy individuals. Of the three subgroups of localized scleroderma, patients with generalized morphoea had the highest levels of serum sCD23. The frequency of IgM antihistone antibody (AHA) and IgM rheumatoid factor (RF), the number of linear lesions, and the frequency of muscle involvement were significantly higher in patients with elevated sCD23 levels than in those with normal levels of sCD23. A significant correlation between the serum sCD23 level and the number of involved areas of the body was observed. Our data suggest that the activation of virgin B cells, which is reflected by elevated sCD23 levels, is closely associated with the production of IgM autoantibodies in localized scleroderma and furthermore that the serum levels of sCD23 are a new serological indicator of the severity of localized scleroderma.

Successful treatment of livedo vasculitis with beraprost sodium: a possible mechanism of thrombomodulin upregulation

BACKGROUND

Livedo vasculitis is thought to be a thrombogenic disorder. We demonstrated that thrombomodulin (TM) expression on the endothelial cells in livedo vasculitis was markedly reduced, while blood tests of coagulation and fibrinolytic activities were within the normal range.

OBJECTIVE

Since prostacyclin (PGI2) upregulates the TM expression of endothelial cells, we tried a PGI2 analogue for the treatment of livedo vasculitis.

METHOD

Four patients with livedo vasculitis were started on a regimen of beraprost sodium (120 micrograms daily). Additional intake of low-dose aspirin was combinated with a maintenance dose of beraprost sodium (60 micrograms daily).

RESULT

All 4 patients experienced a clinical improvement with a combination therapy with beraprost sodium and low-dose aspirin.

CONCLUSION

We propose that PGI2 analogue therapy is useful for the treatment of livedo vasculitis, since the drug upregulates TM expression in this disorder.

Diethyldithiocarbamate, a superoxide dismutase inhibitor, reduces indomethacin-induced gastric lesions in rats

We examined the effect of diethyldithiocarbamate (DDC), the superoxide dismutase (SOD) inhibitor, on the development of gastric lesions induced by indomethacin in rats. Indomethacin (25 mg/kg) was given subcutaneously, and gastric acid secretion, motility, lipid peroxidation, vascular permeability, and myeloperoxidase as well as gastric lesions were measured. Indomethacin produced high-amplitude contractions of the stomach and caused hemorrhagic lesions in the corpus mucosa with significant increase in neutrophil-related processes such as myeloperoxidase activity, vascular permeability and lipid peroxidation. These changes caused by indomethacin were all significantly inhibited by prior administration of atropine (3 mg/kg s.c.). Pretreatment of the animals with DDC (75-1,000 mg/kg s.c.) prevented these lesions induced by indomethacin in the corpus mucosa in a dose-dependent manner (> 100 mg/kg), though at high doses (> 750 mg/kg) some damage was found in both the antrum and duodenum. DDC showed a significant inhibition against the gastric mucosal SOD activity (> 400 mg/kg), yet potently suppressed the increase of lipid peroxidation, vascular permeability, and myeloperoxidase activity caused by indomethacin. DDC dose-dependently (> 75 mg/kg) inhibited the enhancement of gastric motility caused by indomethacin and showed a weak antisecretory effect at high doses (> 750 mg/kg). These results showed that DDC reduced indomethacin-induced gastric lesions by suppressing gastric motility, despite inhibiting SOD activity. This study also indicates the prime importance of gastric hypercontraction in the pathogenesis of this lesion model and suggests that other events including the neutrophil-related processes may be secondary to gastric hypercontraction caused by indomethacin.

Anti-ribosomal P protein antibodies in a Japanese patient with systemic sclerosis

A 56-year-old Japanese woman developed Raynaud's phenomenon and digital ulcerations at the age of 50. She showed rapid and diffuse skin sclerosis; visceral involvement was mild. She showed no symptoms or laboratory findings suggestive of other collagen diseases, including systemic lupus erythematosus and Sjögren's syndrome. Based on the clinical and histological findings, she was diagnosed as having diffuse cutaneous systemic sclerosis (SSc). The patient's serum produced nucleolar and cytoplasmic staining by indirect immunofluorescence analyses on HEp-2 cell substrate and reacted with P0, P1 and P2 proteins in immunoblotting using purified ribosomal antigens. She was negative for anti-topoisomerase I, centromere, and U1RNP antibodies. Antiribosomal P protein antibodies are considered highly specific for systemic lupus erythematosus; this is the first case report of an SSc patient with anti-ribosomal P protein antibodies. The clinical features of SSc patients with these antibodies need to be clarified by an accumulation of cases.

Effectiveness of an inactivated goose parvovirus vaccine in Muscovy ducks

With goose parvovirus (GPV) strain IH, an inactivated vaccine was prepared from allantoic fluid of embryonating Muscovy duck eggs inoculated with GPV. The response to vaccination was measured by virus neutralizing antibody titer against GPV. Offsprings from the vaccinated flock were introduced in a farm in which GPV infection had been experienced and examined for resistance to exposure to GPV. The results showed that the intramuscular vaccination to Muscovy ducks at any age stimulated significant virus neutralizing antibody levels, and that more than 90% Muscovy ducklings from the vaccinated parent flock survived after the exposure to GPV. Muscovy ducklings that passively possessed high level virus neutralizing antibodies also could respond to the vaccination and the induced antibodies remained for more than 2 months.

Clinical evaluation of human granulocyte colony-stimulating factor in chemotherapy for ovarian cancer

The clinical evaluation of human granulocyte colony-stimulating factor (G-CSF) in 38 patients treated with chemotherapy for ovarian cancer stage III was investigated among 3 groups. G-CSF was not given in group A (19 courses), was administered from day 5 of chemotherapy in group B (53 courses), and was given when the WBC count decreased to below 2,000/mm3 in group C (29 courses). The time to nadir was significantly shorter in group B compared with groups A and C and revealed 10 days for the WBC count and 11 days for the neutrophil count (p <0.01), with mean nadir values of 2,896/mm3 and 982/mm3 respectively, and so the count of WBC and neutrophil have been kept during the course. The effect of G-CSF was not modified by age, body weight or the number of chemotherapy courses in groups B and C. These results demonstrate that early treatment with G-CSF may allow increased intensity of chemotherapy by using greater doses or by shortening of the interval between cycles.

Differential chemotactic responses mediated by platelet-derived growth factor alpha- and beta-receptors

We have performed a modified Boyden chamber chemotaxis assay using NRK-49F cells under serum-free condition, in order to characterize the chemotactic activity of recombinant platelet-derived growth factor (PDGF)-AA, -AB, and -BB. All three PDGF isoforms showed similar chemotactic activity on NRK cells expressing both PDGF alpha- and beta-receptors. A checkerboard analysis revealed that PDGF-AA was a true chemoattractant for NRK cells, indicating that alpha-receptors could transduce signals for the chemotactic response. We then examined the inhibitory effects of PDGF isoforms in the upper chamber on NRK cell migration to PDGF in the lower chamber. When higher concentrations of PDGF-AB or -BB were present in the upper chamber, cell migration to any of the PDGF isoforms was completely blocked, whereas PDGF-AA in the upper chamber could not induce complete inhibition of the chemotactic migration to PDGF-AB or -BB. Even when 100 ng/ml of PDGF-AA was present in the upper chamber, NRK cell migration to 5 ng/ml of PDGF-AB in the lower chamber was not completely blocked. These findings suggest that the chemotactic response induced by ligand binding to PDGF beta-receptor may be different from that induced by ligand binding to PDGF alpha-receptors.

Detection of antiribosomal P protein antibodies in patients with systemic sclerosis

This study investigated the prevalence and clinical significance of anti-ribosomal P protein (anti-P) antibodies in patients with systemic sclerosis (SSc). Serum samples from 150 patients with SSc were examined by indirect immunofluorescence. ELISA and immunoblotting. Anti-P antibodies were detected in four (3%) patients with SSc. Three of the four patients showed SSc/SLE (systemic lupus erythematosus) overlap syndrome, but psychiatric disorders were not observed in these patients. By longitudinal immunoblotting analysis one patient, who was initially diagnosed with SSc, later developed anti-P antibodies along clinical manifestations of SLE. Our data suggest that anti-P antibodies are uncommon in SSc and that the presence of anti-P antibodies in patients with SSc indicates an overlap with SLE.

The stimulatory effects of PDGF and TGF-beta 1 on dermal fibroblast attachment

We investigated the effects of various growth factors (platelet-derived growth factor (PDGF), epidermal growth factor (EGF), basic fibroblast growth factor (bFGF), transforming growth factor-alpha (TGF-alpha), transforming growth factor-beta 1 (TGF-beta 1), tumor necrosis factor-alpha (TNF-alpha), keratinocyte growth factor (KGF)) on fibroblast attachment to plastic plates. It is thought that cell attachment to plastic plates in vitro may represent the step between cell migration and proliferation in vivo during wound healing. Among the growth factors examined, only PDGF and TGF-beta 1 significantly increased fibroblast attachment to both uncoated and collagen-coated plates in a concentration-dependent manner. The addition of anti-PDGF antibody abolished the enhancing effect of PDGF but not that of TGF-beta 1, suggesting that the effect of TGF-beta 1 is not through the autocrine induction of PDGF-related activities secreted by the fibroblasts themselves. These data suggest that PDGF and TGF-beta 1 regulate fibroblast attachment to the suitable environment in the process of dermal wound healing in vivo.

Thrombospondin-related adhesive protein (TRAP) of Plasmodium falciparum: expression during sporozoite ontogeny and binding to human hepatocytes

Plasmodium sporozoites collected from oocysts, haemocoel and salivary glands of the mosquito show profound differences in their biological properties such as motility, ability to induce protective immune response and infectivity for vertebrate host cells. Sporozoites from salivary glands are much more infectious than those from oocysts and haemocoel. Differential expression of proteins, such as the circumsporozoite (CS) protein and the thrombospondin-related adhesive protein (TRAP), implicated in sporozoite recognition and entry into hepatocytes may account for the development of infectivity during ontogeny. We have carried out a series of experiments to: (i) analyse the expression and localization of TRAP in P.falciparum sporozoites during development in the mosquito; and (ii) elucidate the biochemical and adhesive properties of recombinant TRAP. Our data indicate that TRAP is not expressed in oocysts, whereas variable amounts of CS protein are found in this parasite developmental stage. Hemocoel sporozoites display the distinct phenotypes TRAP- CS protein+ and TRAP+ CS protein+ at a frequency of 98.5 and 1.5% respectively. Salivary gland sporozoites are all TRAP+ CS protein+. We also provide experimental evidence showing that recombinant TRAP binds to the basolateral cell membrane of hepatocytes in the Disse's space and that sulfated glycoconjugates function as TRAP ligands on human hepatocytes.

An outbreak of goose parvovirus infection in Japan

In a Muscovy duck breeding-growing farm in Aomori prefecture, most of ducklings hatched during spring in 1994 died within two-week-old. The mortality was nearly 100%. In most cases, birds died without clinical signs and some with leg weakness. By serological and virological tests, the outbreak was identified as a goose parvovirus infection. In pathological test, however, no typical manifestations of goose parvovirus infections (hepatitis and intranuclear inclusion bodies in hepatic cells) were detected.