Mitochondrial neurogastrointestinal encephalomyopathy: an autosomal recessive disorder due to thymidine phosphorylase mutations

Mitochondrial neurogastrointestinal encephalomyopathy (MNGIE) is an autosomal recessive disorder defined clinically by severe gastrointestinal dysmotility; cachexia; ptosis, ophthalmoparesis, or both; peripheral neuropathy; leukoencephalopathy; and mitochondrial abnormalities. The disease is caused by mutations in the thymidine phosphorylase (TP) gene. TP protein catalyzes phosphorolysis of thymidine to thymine and deoxyribose 1-phosphate. We identified 21 probands (35 patients) who fulfilled our clinical criteria for MNGIE. MNGIE has clinically homogeneous features but varies in age at onset and rate of progression. Gastrointestinal dysmotility is the most prominent manifestation, with recurrent diarrhea, borborygmi, and intestinal pseudo-obstruction. Patients usually die in early adulthood (mean, 37.6 years; range, 26-58 years). Cerebral leukodystrophy is characteristic. Mitochondrial DNA (mtDNA) has depletion, multiple deletions, or both. We have identified 16 TP mutations. Homozygous or compound heterozygous mutations were present in all patients tested. Leukocyte TP activity was reduced drastically in all patients tested, 0.009 +/- 0.021 micromol/hr/mg (mean +/- SD; n = 16), compared with controls, 0.67 +/- 0.21 micromol/hr/mg (n = 19). MNGIE is a recognizable clinical syndrome caused by mutations in thymidine phosphorylase. Severe reduction of TP activity in leukocytes is diagnostic. Altered mitochondrial nucleoside and nucleotide pools may impair mtDNA replication, repair, or both.

[Molecular studies in Cuban patients with progressive external ophthalmoplegia]

INTRODUCTION

The mitochondria, subcellular organelles which possess their own DNA (mtDNA), produce most of the energy, in the form of ATP, which is necessary for life. This mtDNA may have diverse molecular defects which have been associated with a great variety of clinical syndromes. Deletions in mtDNA are one of the common mutations in patients with mitochondrial myopathies, which in the great majority present with the common symptom of progressive external ophthalmoplegia. In this study we report our findings in eight Cuban families with suspected mitochondrial disease.

OBJECTIVES

To characterize these patients from the molecular point of view, which would allow a preliminary understanding of the behavior of these deletions in Cuban patients.

PATIENTS AND METHODS

We studied nine patients from eight Cuban families in whom mitochondrial encephalomyopathy was suspected. We analyzed the presence of ragged red fibres, the enzymatic activity of the mitochondrial respiratory chain and detection of mtDNA mutations. We used the technique of restriction length polymorphism analysis for detection of deletions.

RESULTS

Histochemical studies showed the presence of COX negative ragged red fibres in seven of the patients studied. The enzymatic activity of the mitochondrial respiratory chain was normal in all the patients. We detected four patients with single deletions of mtDNA, and one with multiple deletions and of the patients had the A3243G mutation.

CONCLUSIONS

With the methods used we were able to determine the presence of a mitochondrial disorder in seven of the eight families studied and deletions of mtDNA were detected as the cause of the illness in five. The disorder was always associated with progressive external ophthalmoplegia and COX negative ragged red fibres.

Direct observation of specific messenger RNA in a single living cell under a fluorescence microscope

We observed the expression of human c-fos mRNA in a living transfected Cos7 cell under a fluorescence microscope by detecting hybrid formed with two fluorescently labeled oligodeoxynucleotides (oligoDNAs) and c-fos mRNA in the cytoplasm. Two fluorescent oligoDNAs were prepared, each labeled with a fluorescence molecule different from the other. When two oligoDNAs hybridized to an adjacent sequence on the target mRNA, the distance between the two fluorophores became very close and fluorescence resonance energy transfer (FRET) occurred, resulting in changes in fluorescence spectra. To find sequences of high accessibility of c-fos RNA to oligoDNAs, several sites that included loop structures on the simulated secondary structure were selected. Each site was divided into two halves, and the pair of fluorescent oligoDNAs complementary to the sequence was synthesized. Each site was examined for the efficiency of hybridization to c-fos RNA by measuring changes in fluorescence spectra when c-fos RNA was added to the pair of oligoDNAs in solution. A 40 mer specific site was found, and the pair of oligoDNAs for the site were microinjected into Cos7 cells that expressed c-fos mRNA. To block oligoDNAs from accumulating in the nucleus, oligoDNA was bound to a macromolecule (streptavidin) to prevent passage of nuclear pores. Hybridization of the pair of oligoDNAs to c-fos mRNA in the cytoplasm was detected in fluorescence images indicating FRET.

Endoscopic injection sclerotherapy for esophageal varices prolonged survival of patients with hepatocellular carcinoma complicating liver cirrhosis

BACKGROUND

A prospective controlled study was performed between 1982 and 1991 to evaluate the efficacy of endoscopic injection sclerotherapy (EIS) in patients with esophageal varices complicated by hepatocellular carcinoma and liver cirrhosis.

METHODS

The study included 83 patients with esophageal varices, hepatocellular carcinoma, and liver cirrhosis. Forty-three patients (group 1) underwent prophylactic EIS or emergent EIS for bleeding varices. EIS was performed weekly 4 to 6 times until the varices disappeared. The remaining 40 patients (group 2) underwent conservative therapy and did not undergo EIS. Survival rates were compared between the 2 groups.

RESULTS

During the 5-year observational period, all patients who did not undergo EIS died. Sixteen in group 2 (40.0%) died of gastrointestinal bleeding including ruptured esophageal varices. In contrast, patients treated with EIS survived significantly longer (p<0.001). Nine patients (20.9%) treated with EIS experienced gastrointestinal bleeding as a result of which 5 (11.6%) died. EIS prolonged survival in patients classified as Child's A or B but did not affect survival in patients with Child's C hepatic function. EIS was effective in prolonging survival in patients with hepatocellular carcinomas smaller than 5 cm. However, EIS had no effect in patients with hepatocellular carcinomas that were larger than 5 cm. EIS prolonged survival only for patients with nodular hepatocellular carcinoma and had no effect in patients with massive and diffuse hepatocellular carcinoma. Further, EIS prolonged survival only for patients who did not have portal vein thrombosis.

CONCLUSION

Based on this prospective study, we concluded that EIS was effective in prolonging the survival period of a select subset of patients with hepatocellular carcinoma.

Differential features of patients with mutations in two COX assembly genes, SURF-1 and SCO2

We screened 41 patients with undiagnosed encephalomyopathies and cytochrome c oxidase (COX) deficiency for mutations in two COX assembly genes, SURF-1 and SCO2; 6 patients had mutations in SURF-1 and 3 had mutations in SCO2. All of the mutations in SURF-1 were small-scale rearrangements (deletions/insertions); 3 patients were homozygotes and the other 3 were compound heterozygotes. All patients with SCO2 mutations were compound heterozygotes for nonsense or missense mutations. All of the patients with mutations in SURF-1 had Leigh syndrome, whereas the 3 patients with SCO2 mutations had a combination of encephalopathy and hypertrophic cardiomyopathy, and the neuropathology did not show the typical features of Leigh syndrome. In patients with SCO2 mutations, onset was earlier and the clinical course and progression to death more rapid than in patients with SURF-1 mutations. In addition, biochemical and morphological studies showed that the COX deficiency was more severe in patients with SCO2 mutations. Immunohistochemical studies suggested that SURF-1 mutations result in similarly reduced levels of mitochondrial-encoded and nuclear-encoded COX subunits, whereas SCO2 mutations affected mitochondrial-encoded subunits to a greater degree. We conclude that patients with mutations in SURF-1 and SCO2 genes have distinct phenotypes despite the common biochemical defect of COX activity.

Mmh/Ogg1 gene inactivation results in accumulation of 8-hydroxyguanine in mice

The major mutagenic base lesion in DNA caused by exposure to reactive oxygen species is 8-hydroxyguanine or 7, 8-dihydro-8-oxoguanine (8-OH-G). Products of the human MMH/OGG1 gene are known to catalyze in vitro the reactions repairing this DNA lesion. To analyze the function of Mmh in vivo, we generated a mouse line carrying a mutant Mmh allele by targeted gene disruption. Mmh homozygous mutant mice were found to have a physically normal appearance, but to have lost nicking activity in liver extracts for substrate DNA containing 8-OH-G, exhibiting a 3-fold increased accumulation of this adduct at 9 weeks of age compared with wild-type or heterozygous mice. Further elevation to 7-fold was observed in 14-week-old animals. Substantial increase of spontaneous mutation frequencies was clearly identified in Mmh mutant mice bearing transgenic gpt genes. These results indicate that exposure of DNA to endogenous oxidative species continuously produces the mutagenic adduct 8-OH-G in mice, and Mmh plays an essential role in repair of this DNA damage.

Involvement of two plasmids in fenitrothion degradation by Burkholderia sp. strain NF100

A bacterium capable of utilizing fenitrothion (O,O-dimethyl O-4-nitro-m-tolyl phosphorothioate) as a sole carbon source was isolated from fenitrothion-treated soil. This bacterium was characterized taxonomically as being a member of the genus Burkholderia and was designated strain NF100. NF100 first hydrolyzed an organophosphate bond of fenitrothion, forming 3-methyl-4-nitrophenol, which was further metabolized to methylhydroquinone. The ability to degrade fenitrothion was found to be encoded on two plasmids, pNF1 and pNF2.

[The C tube in biliary surgery--its development and clinical application]

BACKGROUND

The T tube procedure for bile drainage after biliary surgery has been used all over the world for more than 90 years. However, this method has serious drawbacks: a high complication ratio and a need for long-term hospitalization. Therefore other bile drainage methods including PTGBD, PTBD and ENBD have been developed, but none has so far been able to replace T tube. We have developed a new technique for bile drainage using the C tube (cystic duct tube), which is a slender tube (6Fr. polyvinyl) inserted via the cystic duct into the common bile duct (CBD). We have used C tube in more than 400 cases over the last 20 years: for open surgery during the first 10 years, and for laparoscopic surgery in the last 10 years. Here we describe the history of improvements in the C tube method and the techniques of C tube application in biliary surgery. Elastic surgical suture has been used to fix the C tube to the cystic duct, which successfully prevented bile leakage from the ductal stump after withdrawal of the tube. C tube is not only used for postoperative bile drainage but also for the management of remnant stones. The purpose of this study is to assess the safety and benefits of the C tube procedure.

METHODS

I: From 1980 to 1998, 335 cholecystectomized cases which had undergone the C tube procedure were examined for complications resulting from C tube placement. II: We analyzed 134 patients with choledocholithiasis: 34 patients had been treated using C tube drainage, and 100 patients had been treated with the T tube procedure after undergoing CBD exploration. The main outcome criteria were: the frequency of post-operative complications, quantity of bile drainage, drainage period, and length of post-operative hospital stay. III: Between 1990 and 1999, 131 patients (15.2%) of a total of 860 laparoscopically cholecystectomized patients with gallstones underwent C tube treatment. We assessed the usefulness of the C tube procedure for the detection and management of remnant stones.

RESULTS

I: There were no major complications (bile-leakage, CBD stenosis, etc.) in 335 cases which underwent the C tube procedure. Minor complications related to C tube were: spontaneous withdrawal of the tube in 5 cases, movement of the tube tip in 17 cases, and difficulties during tube removal in 32 cases which included slight resistance. Two cases had liver dysfunction (GOT 705 IU/l and 488 IU/l), although this was easily normalized after withdrawal of the tube tip from the duodenal papillae into the CBD. II: The frequency of complications in patients who underwent the C tube procedure was zero, whilst in the T tube group the major complication rate was 3% and the minor complication rate was 21%. The quantity of bile drainage was 283.6 +/- 22.9 ml/day in the C tube group compared with 302.7 +/- 10.3 ml/day in the T tube group, showing no significant difference. The drainage period (5.9 +/- 0.6 days) in the C tube group was significantly shorter than in the T tube group (27.7 +/- 0.9 days). Hospital stays (11.6 +/- 0.6 days) in the C tube group were significantly shorter than in the T tube group (45.0 +/- 1.5 days). III: Remnant CBD stones were detected by postoperative cholangiography via the C tube in 28 (21.4%) of the C tube replacement cases and in 3.3% of all the laparoscopically cholecystectomized patients. Seventeen patients with remnant stones were managed using glyceryl trinitrate CBD perfusion-induced relaxation of the sphincter of Oddi. The remaining patients were managed with endoscopic papillary balloon dilatation (EPBD) and/or endoscopic sphincterotomy (EST) without reoperation. We also have described other applications of the C tube procedure for the evaluation of sphincter of Oddi motility as an indication for EST, for bile drainage in liver resection, in the treatment of liver injuries, and for duodenal decompression after duodenal surgery. Finally we have mentioned the possibility of C tube application in the management of obstructive jaundice and bile drainage in liver transplantation surgery.

CONCLUSION

The C tube method in biliary surgery is safe and useful in comparison with the T tube method. We are strongly convinced that the T tube will be completely replaced by the C tube.

[Retrospective study of acute myelogenous leukemia in elderly patients: treatment and outcome of 83 consecutive patients]

We retrospectively analyzed treatments and outcomes for 83 acute myelogenous leukemia (AML) patients aged 60 years or more (median age 71) admitted to our hospital between August 1984 and January 1998. Complete remission was achieved in 36% of 78 patients who received anti-leukemic therapy, and median overall survival was 227 days. In addition to abnormal karyotypes involving chromosome 5 or 7, administration of less than 120 mg/m2/course of daunorubicin (DNR) during the initial treatment phase was an unfavorable prognostic factor for both CR and survival. Only 41% of all patients received 120 mg/m2/course of DNR or more, and had a significantly higher CR rate (56%) and longer survival, with a median of 389 days. It was suggested that intensive chemotherapy was effective for selected elderly AML patients who were relatively younger and had good performance status, although the number of such patients was limited in our study.

[Laparoscopic radical nephrectomy for renal cell carcinomas; report on two initial cases]

We recently performed a laparoscopic radical nephrectomy (LRN) on two patients with a renal cell carcinoma. Case 1, a 72-year-old man, was diagnosed as having a renal cell carcinoma 2.5 cm in diameter in the right kidney, and also a submucosal tumor of the cecum. LRN and laparoscopically assisted ileocecal resection were performed using a transperitoneal approach on September 28, 1999. Total operation time and blood loss during the operation were 308 minutes and 320 ml, respectively. The operation time needed for LRN, which was calculated as the total operation time minus the time spent on ileocecal resection, was 199 minutes. There were no complications after surgery, and the patient was recommended for discharge on the 7th postoperative day, but was actually discharged on the 10th postoperative day. Case 2, an 81-year-old man, was diagnosed as having a renal cell carcinoma 3.0 cm in diameter in the right kidney. He had been undergone a total gastrectomy for a gastric carcinoma at age 77, and a sigmoidectomy for a sigmoid colon carcinoma at age 79. A transperitoneal approach was applied for LRN to detect any recurrence of previous carcinomas on September 30, 1999. During adhesiolytic procedures, the colon was injured due to an inappropriate maneuver of the grasping forceps. A small laparotomy (5 cm) was required for repair of the colon. The total operation time and blood loss during surgery were 370 minutes and 850 ml. The operation time calculated from the video of LRN was 274 minutes. Two additional surgical procedures were required in this case. The first was for a postoperative intraperitoneal hemorrhage due to the hemoclip dropping out of the small vein. The second was for hemorrhage in the abdominal wall. Fortunately, the clinical course after surgery was good and the patient was discharged on the 8th postoperative day. There were no complications in case 1. Omitting ileocecal resection was considered to speed up oral intake, leading to earlier discharge. However, major complications occurred in case 2. It is important to clarify the cause of postoperative hemorrhage by careful observation of the video recording, in order to suggest safer procedures in laparoscopic surgery. Although these are only two LRN experiences, we are convinced that LRN can improve postoperative QOL (Quality of life) and is an acceptable alternative for the treatment of renal cell carcinomas.

[Retrospective study of acute myelogenous leukemia in 83 elderly patients: clinical and biological characteristics]

In order to characterize clinical and biological characteristics of elderly patients with acute myelogenous leukemia (AML), we retrospectively analysed 83 elderly patients aged 60 years or more and, as a control, 114 younger patients aged 15 to 59 years who were admitted to our hospital between August 1984 and January 1998. There was a significantly higher incidence of preceding myelodysplastic syndromes in the elderly patients. They also had a significantly higher incidence of unfavorable cytogenetic abnormalities (loss or partial deletion of chromosome 5 or 7) and a significantly lower incidence of favorable cytogenetic abnormalities, such as t(15:17), t(8:21), or inv(16). With regard to FAB subtypes in de novo AML, the incidence of M3 subtype was significantly lower in the elderly group. Myeloperoxidase positivity of AML cells in the elderly group was lower than that in the younger group. Laboratory data at presentation disclosed a lower peripheral leukemic cell count, a higher fibrinogen level, a lower serum protein level, and a higher serum creatinine level in the elderly group. They also had poorer performance status and more frequent concomitant diseases at presentation, including liver diseases, heart diseases, or documented infections. It was concluded that elderly AML patients 60 years or older had a higher incidence of poor prognostic factors compared to younger patients.

Chronic fentanyl treatments induce the up-regulation of mu opioid receptor mRNA in rat pheochromocytoma cells

Chronic activation of adenylate cyclase-cAMP-cAMP-dependent protein kinase (PKA) systems by administration of opioid receptor agonists has been considered as one of the mechanisms of opioid tolerance and dependence. Although analysis of the micro opioid receptor (MOR) gene suggests that cAMP-related signal transduction systems regulate the expression of this gene, which transcription factors affect the MOR gene expression in brain and neural cells has not been clarified. This study deals with the effects of fentanyl on MOR mRNA levels in the rat pheochromocytoma cell line (PC12 cells). PC12 cells were cultured in medium with clinically relevant concentrations of fentanyl. The quantitative reverse transcription and polymerase chain reaction (RT-PCR) method was used for determination of MOR mRNA. Treatment of PC12 cells with fentanyl induced the MOR mRNA up-regulation in a concentration- and time-dependent manner. A cAMP analogue also up-regulated MOR mRNA. The intracellular cAMP level increased after fentanyl treatment. A PKA inhibitor blocked the MOR mRNA up-regulation by fentanyl and the cAMP analogue. Expression of a dominant inhibitory Ras also inhibited the MOR mRNA up-regulation. Fentanyl-induced up-regulation of MOR mRNA via activation of cAMP signaling may be important in compensating for the MOR reduction during long-term treatment of PC12 cells with fentanyl. The present study could be relevant to understanding the molecular mechanisms of opioids in a state of drug tolerance or dependence, and in patients under anesthesia or being treated for pain.

Sensory innervation of the pharynx and larynx

To shed light on supraesophageal complications of reflux disease, sensory innervation--particularly, distinct distribution, area, and density of sensory fibers--of the feline pharyngolaryngeal mucosa was reported. The investigations were performed by means of histochemistry (tracer techniques) and immunohistochemistry. The pharyngeal mucosa from the Eustachian cushion to the middle level of aryepiglottic fold, except the laryngeal surface of epiglottis, was supplied by the glossopharyngeal sensory fibers, whereas the laryngeal sensory fibers innervated between the apex of epiglottis and the level of the first tracheal ring in the larynx and between the middle level of aryepiglottic fold and the caudal end of piriform sinus in the pharynx. Most areas of the mucosa, except the subglottis, had unilateral innervation. The subglottis, including the caudal aspect of vocal fold and the posterior glottis, had bilateral supply with ipsilateral predominance. The density of sensory fibers in the vestibule of larynx involving the posterolateral aspect of arytenoid eminence was much heavier than the other parts. Sensory nerve fibers around the caudal pole of palatine tonsil, and in the root of tongue and the hypopharyngeal wall also were dense. Regional distribution and density of substance P and calcitonin gene-related peptide immunoreactive fibers showed almost the same pattern as did the sensory fibers.

Current status of SOD1 mutations in familial amyotrophic lateral sclerosis

Twenty percent of cases of familial amyotrophic lateral sclerosis (FALS) have identifiable mutations in the gene for Cu, Zn superoxide dismutase (SOD1) located on the long arm of chromosome 21. SOD1 mutations are thought to cause a yet unknown toxic gain of function resulting in motor neuron damage. Seventy-one mutations, located in all five exons of SOD1, have been reported. Identified mutations are predominantly heterozygous mis-sense mutations, although rare nonsense mutations, deletions, and insertions exist. While gene dosage has an effect on the age of onset, genotoype/phenotype correlation is better defined for progression of symptoms than for disease onset.

Fibroblasts in geriatric vocal fold mucosa

Fifty fibroblasts in the macula flava (MF) and 50 fibroblasts in the Reinke's space (RS) of geriatric vocal folds were studied by transmission electron microscopy. Five larynges from autopsy cases in the age range 74-83 years were included in the study. The results were compared with those obtained previously from younger adults. The majority of fibroblasts in RS were spindle-shaped and those in MF were stellate. This was the case with younger adults. The nucleus/cytoplasm (N/C) ratio was 0.5-2.0 in most fibroblasts in RS and MF. Again, this was in common with the findings in younger adults. The development of rough endoplasmic reticulum (rER) and Golgi apparatus (GA) in MF was less marked in the geriatric group than in adults. Glycogen particles were observed in 28 fibroblasts in MF. Lipofuscin granules were found in 12 fibroblasts of RS and 9 cells of MF. The findings suggest a decrease in activities and the presence of ageing processes in fibroblasts of geriatric vocal fold mucosa, to which geriatric changes in the vocal ligament can be attributed.

Rapid discrimination of monkey B virus from human herpes simplex viruses by PCR in the presence of betaine

A PCR method to amplify DNA segments of the glycoprotein G gene of monkey B virus (BV) was achieved by adding betaine to the PCR mixture, in spite of the high G+C content of this gene. No product was obtained when DNA of human herpes simplex viruses (HSVs) was used as the template under the same conditions. Thus, this PCR method is useful in discriminating BV from HSVs.

Alternating combination chemotherapy C-MOPP (cyclophosphamide, vincristine, procarbazine, prednisone) and ABVd (adriamycin, bleomycin, vinblastine, dacarbazine) in clinical stage II-IV Hodgkin's disease: a multicenter phase II study (JCOG 8905). The Lymphoma Study Group of the Japan Clinical Oncology Group

BACKGROUND

The main form of cytotoxic treatment for advanced Hodgkin's disease (HD) is conventional dose multiagents chemotherapy. As HD is not common in Japan, we conducted a phase II study of the commonly used combination chemotherapy (CCT) regimen established in the West for Japanese patients with advanced HD to confirm the efficacy and safety.

METHOD

Between October 1989 and February 1993, a multicenter phase II study of alternating CCT C-MOPP (cyclophosphamide, vincristine, procarbazine, prednisone) and ABVd (adriamycin, vinblastine, bleomycin, dacarbazine) to evaluate its clinical usefulness for clinical stage (cS) II-IV HD was conducted by the Lymphoma Study Group of the Japan Clinical Oncology Group.

RESULTS

Seventy-nine previously untreated patients were enrolled in the study. For 67 eligible patients, the response rate was 92.5% with 83.6% complete response (CR). For 40 cS II and 27 cS III/IV patients the response rate was 95.0% with 90.0% CR and 88.9% with 74.1% CR, respectively. The overall 5-year survival rate was 84.8%. Those of cS II and cS III/IV were 92.5 and 73.1%, respectively. There was no significant difference between cS II and cS III/IV (p = 0.1025). The progression-free 4-year survival rate was 72.8%. Those of cS II and cS III/IV were 77.5 and 65.7%, respectively. There was no significant difference between cS II and cS III/IV (p = 0.2483). Grade 4 toxicity by the criteria of the World Health Organization consisted of leukocytopenia in 28.4% of patients. There was GPT elevation in 4.5%, nausea/vomiting in 11.9% and CNS in 1.5% of patients, but there was no treatment-related death.

CONCLUSION

The C-MOPP/ABVd regimen for Japanese patients with advanced HD is considered to be one of the effective CCTs according to the results of the present phase II study.

Efficacy of temporal musculopericranial flap for reconstruction of the anterior base of the skull

Since March 1988 the temporal musculopericranial (TMP) flap has been used as our flap of choice to reconstruct defects of the anterior base of the skull that are larger than 2 x 3 cm, including the dura mater, in 33 patients. The primary diseases were malignant head and neck tumours (n = 16), trauma (n = 15), meningioma (n = 1), and teratoma (n = 1). The dura mater was reconstructed with a unilateral TMP flap, after which the cranial and nasal cavities were closed with the opposite TMP flap. In addition, bone was grafted by sandwiching the bone between the two flaps and fixing it to the surrounding residual bone. When a large area was resected, making it impossible to use a TMP flap, a frontal musculopericranial (FMP) flap or a free flap (usually the rectus abdominis myocutaneous flap) was used to close the cranial and nasal cavities. Thirty of the 33 patients recovered with no postoperative complications. Two patients developed extradural abscesses in the anterior base of the skull and one developed mild meningitis, but they were successfully treated conservatively. When bilateral TMP flaps were used for the reconstruction, no patient had aesthetic problems in the forehead region. The TMP flap is extremely effective for the reconstruction of the anterior base of the skull because it is minimally invasive and causes few aesthetic problems in the forehead region.

Effect of atypical antipsychotics on phencyclidine-induced expression of arc in rat brain

The effect of atypical antipsychotics on the immediate-early gene, arc (activity-regulated cytoskeleton-associated gene), expression was investigated in phencyclidine (PCP)-treated rats using RT-PCR. Administration of PCP (10 mg/kg) increased arc mRNA levels in the prefrontal cortex, nucleus accumbens and posterior cingulate cortex. Pretreatment with clozapine (20 mg/kg), olanzapine (10 mg/kg) and risperidone (2 mg/kg), but not haloperidol (2 mg/kg), prevented PCP-induced arc expression in the prefrontal cortex and nucleus accumbens. Pretreatment of haloperidol increased the striatal arc mRNA levels. Clozapine, olanzapine and haloperidol inhibited the PCP-induced arc expression in the posterior cingulate cortex. These results suggest that the effects of antipsychotic drugs on PCP-induced arc expression in the prefrontal cortex and nucleus accumbens are useful for distinguishing atypical antipsychotic properties of the drugs.

Comparative histology of the maculae flavae of the vocal folds

A light and electron microscopic comparative investigation of the maculae flavae of the vocal folds was carried out on excised human and canine adult larynges. The structure and functions of human adult maculae flavae (HMF) were found to differ from those of canine adult maculae flavae (CMF). The maculae flavae were composed of fibroblasts, elastic and collagenous fibers, and ground substance in humans and canines. The density of fibroblasts in HMF was found to exceed that in CMF. Fibroblasts in HMF were stellate with processes or spindle-shaped, and the nucleus-cytoplasm (N/C) ratio was small. Rough endoplasmic reticulum and Golgi apparatus were well developed in the cytoplasm. Fibroblasts in CMF were oval, and the N/C ratio was large. Endoplasmic organs were poorly developed in the cytoplasm. Synthesized elastic and collagenous fibers were more numerous in HMF than CMF, and the density of both in HMF was much greater than that in CMF. Ground substance was more abundant in CMF than HMF. Apparently, CMF did not produce elastic and collagenous fibers in amounts sufficient to develop vocal ligaments. The HMF contributes to the formation of the vocal ligaments and the layered structure of human vocal folds.

Oxygen-related intrinsic defects in glassy SiO2: interstitial ozone molecules

Interstitial O3 molecules in 7.9 eV photon-irradiated silica are identified. Their optical absorption band at 4.8 eV nearly coincides with the 4.8 eV band of nonbridging oxygen hole centers. The O3-related band is distinguished by a smaller halfwidth (0.84 vs 1. 05 eV), by susceptibility to ultraviolet bleaching, by lack of correlation to the 1.9 eV luminescence band, and by rise of a singlet O2 luminescence band at 0.974 eV during photobleaching. This identification solves a long controversy on the nature of optical bands in silica and gives a tool for studying the mobility of atomic oxygen in SiO2.

Analysis of mtDNA deletions in muscle by in situ hybridization

We compared the distribution of deleted mitochondrial DNA (Delta-mtDNA) in skeletal muscle of a patient with autosomal recessive (AR) and another with autosomal dominant (AD) progressive external ophthalmoplegia (PEO) by in situ hybridization (ISH). The patients studied had similar numbers of fibers deficient in cytochrome c oxidase (COX) activity (13.6% and 12.8%) and fibers with mitochondrial proliferation (5.5% and 5.3%). ISH suggested that each COX-deficient fiber contained a single species of Delta-mtDNA. Most deletions ablated the region between the genes encoding adenosine triphosphate (ATP) synthase subunit 8 and cytochrome b. Fibers that appeared to be depleted of mtDNA were also present. We conclude that muscle from patients with autosomally inherited PEO contains not only Delta-mtDNA but also focal depletion of mtDNA and that the distribution of these mtDNA defects appears to be similar. These changes most likely represent the common consequence of whatever genetic factors are responsible for the generation of Delta-mtDNA.

Effect of polaprezinc on healing of acetic acid-induced stomatitis in hamsters

PURPOSE

The purpose of this work was to investigate the potential effectiveness of polaprezinc in the treatment of stomatitis. Its effect on oral mucous membrane lesions was studied focusing on acetic acid-induced stomatitis in an animal model.

METHOD

Stomatitis was induced in hamsters by local injection of 30 microL of 10% acetic acid solution into both cheek pouches. Change of the size of the acetic acid-induced white lesion caused by polaprezinc injection was compared with that of control (water injection). The process of healing of damaged membrane was also investigated histopathologically. Selective adhesion of polaprezinc on mucous membrane was studied using color development by complexation between zinc and dithizone.

RESULTS

On day 4 after acetic acid injection, round white lesions were observed in the central area of both pouches. Observation on days 7, 10, and 14 showed that the size of the lesions decreased with time. Comparison with the control group of animals, in which healing took place naturally, showed that daily administration of polaprezinc (10 mg/kg) applied to the cheek pouches significantly promoted healing of the lesion from day 7 onward. Histopathological investigation of the mucous membrane in the cheek pouches 7 days after the induction of stomatitis by acetic acid injection showed thickening, and cell damage was evident. In the group of animals treated with polaprezinc, the thickening of the mucous membrane was less than that in animals of the group receiving no treatment and regeneration of damaged tissue was observed after 6 days of polaprezinc treatment.

CONCLUSION

Polaprezinc is an effective treatment in this animal model of acetic acid-induced stomatitis. This suggests that the drug may be useful in promoting healing of stomatitis in the clinical setting. Extrapolating these to humans suggests that the drug has healing effect to severe stomatitis induced by anticancer drug therapy.

Relation of lifestyle factors to metacarpal bone mineral density was different depending on menstrual condition and years since menopause in Japanese women

OBJECTIVE

To examine whether the relation between lifestyle and metacarpal bone mineral density (BMD) varied with life-stages.

DESIGN

Cross-sectional study.

SETTING

Taking questionnaires related to lifestyle and examining metacarpal BMD by computed X-ray densitometry at a local health care center.

SUBJECTS

Out of 750 Japanese women aged 40-69 y old who underwent screening for osteoporosis, we selected 535 healthy subjects without medical conditions or lifestyle factors known to affect bone metabolism.

RESULTS

A cross-sectional comparison of BMD and years since menopause (YSM) resulted in a logarithmic regression model (BMD=2. 539-0.149xloge YSM, r2=0.418), indicating that a prominent reduction in metacarpal BMD appears up to 4-6 y after menopause. In premenopausal women with regular menstruation, those who engaged in regular physical activity during adolescence showed significantly greater BMD than those who did not. In 1-5-y postmenopausal women, those with current calcium intake of more than 800 mg/d, current milk intake greater than 900 ml/week, daily consumption of milk and/or dairy products, or frequent consumption of small fish showed significantly greater BMD. In 6-15-y postmenopausal women, those who took more than 6000 or 8000 steps/day showed significantly greater BMD.

CONCLUSIONS

The relation between lifestyle and BMD differed with life-stages in Japanese women. It was suggested that to perform lifestyle modifications for the prevention of osteoporosis, life-stages should be taken into consideration.

SPONSORSHIP

Grant for Research on Health Service from Ministry of Health and Welfare, Japan and grant from The National Dairy Promotion and Research Association of Japan. European Journal of Clinical Nutrition (2000) 54, 9-13

Expression of PDGF-beta receptor, EGF receptor, and receptor adaptor protein Shc in rat osteoblasts during spaceflight

A number of studies have indicated that microgravity induces osteopenia and modulates functions of mammalian cells. However, the molecular mechanisms underlying these effects of microgravity are still unknown. Rat osteoblasts were cultured for 4 and 5 days during Shuttle-Spacelab flight, and fixed by guanidine isothiocyanate solution on board after treatment with 1alpha, 25 (OH)2 vitamin D3. The mRNA levels for platelet-derived growth factor (PDGF)-beta receptor, epidermal growth factor (EGF) receptor, the growth factor receptor adaptor protein Shc, and c-fos were determined using the method of quantitative reverse transcription-polymerase chain reaction. The mRNA levels for EGF receptor were not altered by microgravity. However, the mRNA levels for PDGF-beta receptor, Shc, and c-fos were decreased to 62, 55 and 25% on the 4th day of flight, and 47, 40, and 43% on the 5th day, respectively, as compared to the corresponding ground controls. Expression of the growth factor receptor and the receptor adaptor protein was modulated in rat osteoblasts during spaceflight. Data suggest that signal transduction via growth factor receptors in rat osteoblasts is impaired by microgravity. Dysfunction of osteoblasts might be involved in spaceflight-induced osteopenia.

Autobiographical recollection and affects of cues in an amnesic patient

The individual described herein (Y.K.) is a pure amnesic patient with severe anterograde amnesia and a selective loss of specific personal episodes in his remote memories. In this study, we examined whether more concrete cues could elicit specificity in his autobiographical memory. It was found that the richness of his autobiographical memory under the condition with probes was significantly higher than condition without probes, although Y.K.'s performance on recalling autobiographical memory was inferior to that of control subjects under both conditions. These results and our previous findings indicate that neither the disorder at the level of the framework's thematic retrieval nor the destruction of individual traces will account for the loss of Y.K.'s autobiographical memory. We suspect that Y.K.'s loss of autobiographical memory may be due to problems in the interface between thematic retrieval frameworks and individual traces.

Synthetic phytanyl-chained glycolipid vesicle membrane as a novel matrix for functional reconstitution of cyanobacterial photosystem II complex

The vesicles composed of synthetic phytanyl-chained glycolipid and natural sulfoquinovosyldiacylglycerol at 9:1 molar ratio were successfully applied to functional reconstitution of photosystem II complex (PS II) from a thermophilic cyanobacterium. The synthetic glycolipid employed was one of our model archaeal diether lipids, 1, 3-di-O-phytanyl-2-O-(beta-D-maltotriosyl)glycerol. The light-induced oxygen-evolving activity of PS II reconstituted in the glycolipid vesicles was approximately 6-fold higher than that reconstituted in several phosphatidylcholine vesicles. The present results reveal the first evidence that a well-designed synthetic glycolipid is effective for the functional reconstitution of complicated and labile membrane protein complexes, such as PS II.

Cellular and molecular studies in muscle and cultures from patients with multiple mitochondrial DNA deletions

In the last decade, several mitochondrial encephalomyopathies have been pathogenically associated with large-scale mitochondrial DNA deletions that are sporadic, or with point mutations that are maternally inherited. The mutations were also demonstrated in cultures of muscle satellite cells obtained from the patients. Subsequently, multiple deletions in mitochondrial DNA were found in several families. The affected members had progressive external ophthalmoplegia, cataracts and limb weakness, inherited as an autosomal dominant trait, or progressive external ophthalmoplegia with neurogastrointestinal encephalomyopathy or with cardiomyopathy, inherited as an autosomal recessive trait. To better understand the developmental pathobiology and localization of the multiple deletions, we performed comparative molecular genetic studies in muscle and cultures from patients. Whereas multiple deletions were found in muscle fragments from which muscle satellite cells were removed by enzymatic digestion, no deletions were found in the satellite cells or their cultured progeny. Our results suggest that multiple mitochondrial DNA deletions arise as somatic mutations during later stages of muscle development, or in terminally differentiated myofibers.

Electron microscopic and immunohistochemical investigation of Reinke's edema

Examination was made of the vocal fold mucosa of Reinke's edema immunohistochemically and electron microscopically, with special attention to blood vessels in Reinke's space (RS). Ten surgical specimens of Reinke's edema were used, and the results obtained are summarized as follows. There were subepithelial vascularization and many dilated vessels in RS. The vessels had thin endothelium with many fenestrae, many vesicles, and a thickened basement membrane. Plasma exuded from the capillaries into surrounding tissue via fenestrae. These findings demonstrate increased permeability of the vessels. The vascular walls were thin, with few pericytes. The pericytes were situated away from the endothelial cells. Some endothelial cells and pericytes had degenerated, and vessel occlusion was apparent in some cases. These findings indicate the vessels had become fragile. Interstitial cells and/or inflammatory cells in RS showed stained cytoplasm with vascular endothelial growth factor. This growth factor may possibly enhance capillary permeability and form fragile vessels in RS. Fragility and alteration in permeability of the vessels are presumed to cause edema of RS, which may progress to Reinke's edema.

Fatal infantile cardioencephalomyopathy with COX deficiency and mutations in SCO2, a COX assembly gene

Mammalian cytochrome c oxidase (COX) catalyses the transfer of reducing equivalents from cytochrome c to molecular oxygen and pumps protons across the inner mitochondrial membrane. Mitochondrial DNA (mtDNA) encodes three COX subunits (I-III) and nuclear DNA (nDNA) encodes ten. In addition, ancillary proteins are required for the correct assembly and function of COX (refs 2, 3, 4, 5, 6). Although pathogenic mutations in mtDNA-encoded COX subunits have been described, no mutations in the nDNA-encoded subunits have been uncovered in any mendelian-inherited COX deficiency disorder. In yeast, two related COX assembly genes, SCO1 and SCO2 (for synthesis of cytochrome c oxidase), enable subunits I and II to be incorporated into the holoprotein. Here we have identified mutations in the human homologue, SCO2, in three unrelated infants with a newly recognized fatal cardioencephalomyopathy and COX deficiency. Immunohistochemical studies implied that the enzymatic deficiency, which was most severe in cardiac and skeletal muscle, was due to the loss of mtDNA-encoded COX subunits. The clinical phenotype caused by mutations in human SCO2 differs from that caused by mutations in SURF1, the only other known COX assembly gene associated with a human disease, Leigh syndrome.

[Cauda equina syndrome due to recurrent malignant lymphoma of the spinal cord. A case report]

A 50-year-old man noticed a mass in the right cervical region and presented to our hospital. He underwent biopsy of a cervical lymph node, which revealed non-Hodgkin's lymphoma (diffuse large B cell, lymphoblastic type) histologically. He was treated with chemotherapy (CHOP) and radiation, and achieved complete remission. Two months later, he was admitted because of distal pain and extensive numbness of the lower limb as well as weakness of the left leg. Lumbar MRI showed an area of abnormal intensity in the cauda equina. Cytological examination of cerebrospinal fluid showed class V (lymphoma cells), so he was diagnosed as having recurrent malignant lymphoma of the spinal cord. He was treated with intrathecal chemotherapy and irradiation. After the treatment the mass in the cauda equina disappeared and the neurological symptoms in his legs resolved. It is rare for malignant lymphoma to recur in the spinal cord, particularly the cauda equina. It is well known that cauda equina syndrome can be caused by vertebral lesions and primary spinal cord tumors, but it is also necessary to keep malignant lymphoma of the cauda equina in mind.

Alternating combination chemotherapy COP (cyclophosphamide, vincristine, prednisone) and MP (melphalan, prednisone) in multiple myeloma: a multicenter phase II study (JCOG8906). Lymphoma Study Group of the Japan Clinical Oncology Group

BACKGROUND

The main form of cytotoxic treatment for multiple myeloma (MM) is conventional dose chemotherapy at present.

METHOD

Between November 1989 and December 1991, a multicenter phase II study of alternating conventional dose combination chemotherapy (CCT) with COP (cyclophosphamide, vincristine, prednisone) and MP (melphalan and prednisone) to evaluate its clinical usefulness for overt MM patients was conducted by the Lymphoma Study Group of the Japan Clinical Oncology Group (JCOG).

RESULTS

Eighty-one previously untreated patients were enrolled in the study. For 69 eligible patients, the response rate was 50.7% [95% confidence interval (CI) 38.4-63.0%]. The median survival time was 38.5 (95% CI 32.0-44.4) months. The survival rate at 3 and 5 years was 50.7 and 27.3%, respectively. Grade 4 toxicity by the criteria of the World Health Organization consisted of anemia in eight patients, leucocytopenia in three, cardiac in one and hepatic in two, but there was no treatment-related death.

CONCLUSION

The COP-MP regimen for overt MM is thought to be one of the effective CCTs according to the results of the present phase II study.

Activation of Ca(2+)-dependent K(+) current by nordihydroguaiaretic acid in porcine coronary arterial smooth muscle cells

The effects of nordihydroguaiaretic acid (NDGA), a lipoxygenase inhibitor and an antioxidant, on membrane currents were examined in single smooth muscle cells isolated from porcine coronary artery. Spontaneous transient outward currents (STOCs) recorded at -30 mV were markedly enhanced by NDGA (>/=10 microM). Pretreatment with caffeine and ryanodine abolished STOCs and reduced NDGA-induced increase in outward current at -30 mV by approximately 60%. NDGA showed dual action on an outward current elicited by step depolarization from -60 to 0 mV: inhibition and enhancement at concentrations of 3 and >/=10 microM, respectively. In the presence of Cd(2+), the inhibition of outward current by NDGA disappeared and the enhancement remained. NDGA inhibited both the voltage-dependent Ca(2+) channel current (IC(50) = 2.5 microM) and the delayed rectifier K(+) current (IC(50) = 9.8 microM). The NDGA-induced enhancement of STOCs and outward currents on depolarization was abolished by 100 nM iberiotoxin but was not affected by glibenclamide or apamin. Under current clamp mode, 30 microM NDGA significantly hyperpolarized myocytes. The application of lipoxygenase inhibitors (caffeic acid and esculetin), a cyclooxygenase inhibitor (indomethacin), antioxidants (ascorbic acid and erythorbic acid), and structural-related compounds of NDGA (catechol and dopamine) did not enhance K(+) currents. These results indicate that the opening of the large conductance Ca(2+)-dependent K(+) channel by NDGA, which is independent of its lipoxygenase inhibition or antioxidant effect, results in membrane hyperpolarization.

[Clinical manifestation and molecular identification of patients with Leber's hereditary optic neuropathy in a national reference center for neuro-ophthalmology in Cuba]

INTRODUCTION

Leber's hereditary optic neuropathy (LHON) is a mitochondrial disorder, confirmed at a molecular level 10 years ago. This had permitted better understanding of the condition. Since 1998, the Instituto de Neurología y Neurocirugía has used these techniques for the study of mutations which are considered to be the origin of the disorder.

PATIENTS AND METHODS

We describe the characteristics of 14 cases from 10 families with LHON and the molecular confirmation found between 1994 and 1998 in the Instituto de Neurología Neurocirugía de Cuba. We also review the few cases seen in the previous 18 years. These were from only two families. They were diagnosed on clinical grounds and in view of maternal inheritance.

RESULTS AND CONCLUSIONS

In 80% of the families in which the presence of primary mutations was investigated there was A117789, and in 20% A3460G. The average age of appearance was 28 years. The ages of onset were within the limits of 11 years and 48 years. There were 43% women. Two cases were considered to be sporadic. The clinical features corresponded to those described in such cases, with severe visual defects, central scotomas, very reduced colour vision and severely altered visual evoked potentials, with normal diffuse light and pattern electroretinograms. An improvement in visual acuity of 0.2 was seen in two cases. Microangiopathy, described as characteristic of the early stages of this disorder was detected in five cases, in at least one eye. The others had different degrees of optic atrophy. Two generations of one complete family, all with mutation 3460, were studied. In several families with this mutation alterations were found in the colour vision test of Farnsworth Munsell Hue 100 and also microangiospathy of the retina.

Sulfamethizole capsules containing contrast medium for assessment of gastric emptying in functional dyspepsia patients

The usefulness of sulfamethizole capsules containing contrast medium in gastric emptying tests for functional dyspepsia was evaluated in five healthy volunteers and nine patients with dysmotility-like symptoms. Each subject swallowed 15 capsules with a liquid, food, and at 0, 15, 30, 45, 60, 90, and 120 min, the capsule position and size were monitored fluoroscopically for 30 sec and radiograms were obtained. Blood sulfamethizole concentrations were also measured at the same time. Visualized capsule movement from the proximal to distal stomach up to 60 min was faster in the patients, whereas in the later digestion period, proximal stomach emptying in the patients was delayed significantly (P < 0.05), and the number of capsules remaining in the distal stomach at 120 min was significantly larger in the patients (P < 0.05). This test method was evaluated as being useful in monitoring solid emptying in normal and pathophysiologic conditions.

Expression of 5-HT2A and 5-HT1B receptor mRNA in blood vessels

Expression of two subtypes of 5-hydroxytryptamine (5-HT) receptors, 5-HT1B and 5-HT2A, was investigated in normal rat arteries (abdominal aorta) and veins (inferior vena cava) by the quantitative reverse transcription-polymerase chain reaction (RT-PCR). The arterial 5-HT2A receptor mRNA level in artery was 25-fold (p < 0.01) higher than the venous level, and the arterial 5-HT1B receptor mRNA level was at least 7000-fold (p < 0.005) higher the venous level.

Space flight modulates signal transduction pathway of growth factor receptors in rat osteoblasts

Bone metabolism is regulated by the balance of bone formation and resorption. Osteoblasts serves primarily for bone formation. Microgravity deteriorates osteoblastic function and inhibit bone formation. Growth factors regulate osteoblast function via receptors. Binding of EGF and PDGF to the receptors activates receptor tyrosine kinase and rapid association of adapter proteins Shc and Grb2, and evokes the Ras/MAP kinase cascade. Signals from various chemical and physical stimuli are transmitted to the nucleus, and induce c-fos and c-jun gene expression. However, effects of microgravity on the molecular events in osteoblasts remain unknown. The purpose of this study is to investigate the mRNA levels for PDGF-beta receptor, EGF receptor, Shc, and c-fos in rat osteoblasts during space flight.

[Leber's hereditary optic neuropathy and its possible relation to a recent epidemic in Cuba]

INTRODUCTION

This century, the greatest epidemic affecting the nervous system was notified in Cuba seven years ago. At the present time the epidemic continues although to a lesser extent. The clinical findings of the illness were mainly bilateral optic neuropathy sometimes accompanied by other symptoms and peripheral neuropathy. The similarity of the optic form of the illness with Leber's hereditary optic neuropathy, and their common risk factors, were obvious from the beginning.

PATIENTS AND METHODS

Statistics from the national reference department of neuro-ophthalmology of the Instituto de Neurologia de Cuba were reviewed. From these it was evident that the number of cases of Leber's hereditary optic neuropathy had increased in recent years, coinciding with the period of epidemic and endemic Cuban neuropathy. Many of these patients had previously been diagnosed as having epidemic optic neuropathy.

RESULTS

We describe the characteristics of a group of these patients and discuss the differences and possible relationship between the two conditions. In the case of epidemic optic neuropathy, there is strikingly simultaneous loss of vision, less visual changes with much smaller cecocentral scotomas, loss of ganglion fibres of the retina around the papillomacular bundle, a good response to multivitamin treatment, and increased frequency of association with peripheral sensory neuropathy.

CONCLUSION

This analysis reinforces the hypothesis that many patients with Leber's hereditary optic neuropathy, which started at the time of the epidemic, were incorrectly classified as suffering from this, and also perhaps their condition worsened due to the toxic nutritional features common to both conditions.

[Evaluation of cytarabine-induced apoptosis in leukemic cell lines; utility of annexin V method]

Apoptosis is a morphologically and biochemically distinct form of cell death that occurs under a variety of physiological and pathological conditions. In the present study, using leukemic cell lines, time course of cytarabine-induced apoptosis was examined morphologically, using annexin V method, TUNEL method and fluorometric assay for caspase-3 activity. Morphological changes characteristic of apoptosis were observed in U937 and HL60 cells after 4-hour incubation with cytarabine and progressively evident until 48-hour incubation, but rarely found in K562 cells. In annexin V method and assay for caspase-3 activity, changes accompanied by apoptosis could also be detected at 4-hour incubation with cytarabine, but in TUNEL method, they were not found until 24-hour incubation. The advantage of annexin V method which detects phosphatidylserine emerging on cell surface during the early course of apoptosis included simplicity and rapidity of the procedure and short time requirement for apoptosis to appear after incubation with cytarabine. Usefulness of annexin V method in a study of clinical samples was discussed.

Maternally inherited hearing loss in a large kindred with a novel T7511C mutation in the mitochondrial DNA tRNA(Ser(UCN)) gene

Thirty-six of 43 maternally related members of a large African American family experienced hearing loss. A muscle biopsy specimen from the proband showed cytochrome c oxidase (COX)-deficient fibers but no ragged-red fibers; biochemical analysis showed marked reduction of COX activity. A novel T7511C point mutation in the tRNA(Ser(UCN)) gene was present in almost homoplasmic levels (>95%) in the blood of 18 of 20 family members, and was also found in lower abundance in the other two. Single-fiber PCR showed that the mutational load was greater in COX-deficient muscle fibers. The tRNA(ser(UCN)) gene may be a "hot spot" for mutations associated with maternally transmitted hearing loss.

Binding of human secretory leukocyte protease inhibitor in uterine cervical mucus to immunoglobulins: pathophysiology in immunologic infertility and local immune defense

OBJECTIVE

To identify an Fc receptor-like molecule in human cervical mucus.

DESIGN

Controlled experimental laboratory study.

SETTING

Department of Obstetrics and Gynecology, School of Medicine, University of Tokushima.

PATIENT(S)

Women undergoing treatment for infertility.

INTERVENTION(S)

Sodium dodecyl sulfate-polyacrylimide gel electrophoresis and Western blot were used for analysis.

MAIN OUTCOME MEASURE(S)

A water-insoluble protein with immunoglobulin-binding activity was purified from human cervical mucus by ammonium sulfate fractionation. The initial 21 amino acids of the N-terminus of the immunoglobulin-binding protein were determined and analyzed in a computer search for homology.

RESULT(S)

The purified fraction contained a 15-kd protein that binds immunoglobulin A, immunoglobulin M, and all subclasses of human immunoglobulin G as determined by Western blot analysis. The amino acid sequence of the N-terminus is identical to that of secretory leukocyte protease inhibitor. The capacity of secretory leukocyte protease inhibitor to bind immunoglobulins was confirmed by Western blot analysis.

CONCLUSION(S)

A component in human cervical mucus capable of binding immunoglobulins was identified as secretory leukocyte protease inhibitor. The capacity to bind immunoglobulins is a unique property of the protein, providing additional support for the contention that it plays an important physiologic role in local tissue defense mechanisms. It also is involved in the pathogenesis of immunologic infertility by trapping sperm in the cervical mucus.

Troglitazone inhibits the capacitative Ca2+ entry in endothelial cells

To investigate the effects of troglitazone on the capacitative Ca2+ entry, we monitored changes in cytosolic Ca2+ concentrations ([Ca2+]i) induced by thapsigargin in fura-2-loaded porcine endothelial cells in situ and in primary culture. In aortic valve endothelial cells in situ, thapsigargin induced sustained elevation of [Ca2+]i. Both troglitazone and SKF 96365 inhibited the steady state increase in [Ca2+]i in a concentration-dependent manner. At 30 microM, troglitazone and SKF 96365 inhibited the [Ca2+]i elevation to 19.4 +/- 3.6% and 43.9 +/- 4.5%, respectively. In aortic endothelial cells in primary culture, both troglitazone (10 microM) and SKF 96365 (100 microM) completely inhibited the thapsigargin-induced [Ca2+]i increase. The EC50 value of troglitazone (1.4 +/- 0.1 microM) was lower than that of SKF 96365 (10.0 +/- 3.3 microM). We suggest that troglitazone would be a useful tool to investigate the capacitative Ca2+ entry.

Prospective study of interferon therapy for compensated cirrhotic patients with chronic hepatitis C by monitoring serum hepatitis C RNA

Because interferon therapy exhibits low efficacy for cirrhotic patients infected with hepatitis C virus, this prospective study was conducted to determine effective interferon regimens tailored to treatment response by monitoring HCV RNA status. A total of 157 cirrhotic patients were enrolled to receive 9 million units (MU) of interferon three times a week. The HCV RNA values were drawn 8 weeks apart and the patients were randomized to a further 16 or 32 weeks of treatment after two sequential findings of negativity for HCV RNA. A total of 73 out of 157 patients (46%) proceeded to randomization to different durations of treatment, 37 short-course and 36 long-course (duration: 38 +/- 8 and 49 +/- 13 weeks; total amount of interferon: 940 +/- 240 and 1130 +/- 390 MU, respectively). The remaining 84 patients without two sequential negative serum HCV RNA determinations received 44.8 +/- 27.4 weeks of interferon (IFN) therapy with total amount of 993 +/- 633 MU. Of these 157 patients, sustained virological and biochemical response was shown in 32 (20%) and 37 patients (24%), respectively. Sustained virological and biochemical response rate in the randomized patients was significantly higher than in nonrandomized patients (41% vs. 2%, and 38% vs. 11%; each P <.01). Of the 73 randomized patients, the rate of sustained virological response in patients with long-course treatment (50%) was significantly higher than that of patients with short-course treatment (32%) (P =.026: log-rank test), and in patients with early disappearance of HCV RNA especially within 8 weeks, in patients with low virus load (</=10(6.3) copies/mL) and with HCV 2a. Multivariate analysis revealed that HCV RNA level and subtypes were the most important factors contributing to sustained virological response. Interferon is effective even in cirrhotic patients with low viral load and HCV 2a, but requires a longer course of administration.

Leber's hereditary optic neuropathy mitochondrial DNA mutations in familial multiple sclerosis

Leber's hereditary optic neuropathy (LHON) can be difficult to distinguish from optic neuritis due to multiple sclerosis (MS). For several decades an association of LHON and MS has been suspected, and within the past 7 years the LHON nucleotide (nt)-3460 and nt-11778 mtDNA mutations have been identified in several patients with MS-like phenotypes. To further study this association, we tested 42 index patients with clinically definite, familial MS for the LHON mtDNA mutations at nt-3460, nt-11778, and nt-14484. No patients had a pathogenic LHON mtDNA mutation; however, two MS patients with unilateral optic neuritis harbored the nt-15257 mtDNA polymorphism that was reported originally as a pathogenic LHON mutation. Several investigators have shown evidence that the nt-15257 mtDNA mutation is not primarily pathogenic. Therefore, we conclude that pathogenic LHON mtDNA mutations are absent or rare in unselected patients with familial, clinically definite MS (95% confidence intervals for each of the negative mutations 0-7.0%).

Neonatal presentations of mitochondrial metabolic disorders

Because of the high energy requirements of the growing neonate, disorders of mitochondrial metabolism caused by defects in fatty acid oxidation, pyruvate metabolism, and the respiratory chain may often present in the neonatal period. Common neonatal presentations are hypotonia, lethargy, feeding and respiratory difficulties, failure to thrive, psychomotor delay, seizures, and vomiting. Laboratory clues include alterations in the levels of lactate, pyruvate (and the lactate/pyruvate ratio), glucose, and ketone bodies. Diagnosis usually depends on specific enzyme assays or on molecular genetic analysis. Without treatment, most infants die in the first few days or months of life. In the last decade, there have been significant advances in the understanding of the molecular basis of these disorders. This review discusses the major subgroups of mitochondrial disorders, focusing on defects of pyruvate oxidation, the Krebs cycle, and the respiratory chain. Disorders caused by respiratory chain defects may involve nuclear DNA, mitochondrial DNA, or intergenomic signaling. Recognition and early diagnosis of these conditions are important in the genetic counseling of these families.

Morphological observation of laryngeal motoneurons by means of cholera toxin B subunit tracing technique

Gross anatomical and histological studies and immunohistochemical demonstration of cholera toxin B subunit used as a retrograde tracer were performed to investigate distinct muscle fibre bundles (MFBs) in the feline intrinsic laryngeal muscles (ILMs) and to characterize the respective supplying motoneurons in the nucleus ambiguus (AM). Distinct bundles were observed in all ILMs except the lateral cricoarytenoid muscle. Motoneurons supplying MFBs related to phonation located more medially than others. Motoneuron size did not differ between distinct MFBs in the same muscle. Neurodendrites for the cricothyroid muscle (CT) and adductor motoneurons extended dorsomedially, ventrolaterally and ventromedially, while those for the posterior cricoarytenoid muscle (PCA) motoneurons stretched dorsomedially and ventrolaterally. We conclude that distinct MFBs in ILMs play different roles in laryngeal functions, and that corresponding motoneurons have their own specific visceroneural nature allowing regulation of complex laryngeal functions. To receive information from the central nervous system, laryngeal motoneuron dendrites extended to regions locating respiratory, phonatory and swallowing neurons.