The role of cell adhesion molecules in allograft rejection after penetrating keratoplasty in mice. Clinical and immunohistochemical study

BACKGROUND

It has been reported that adhesion molecules play an important role in immunological rejection after organ transplantation. In the present study, we examined the role of ICAM-1/ LFA-1 adhesion molecules in corneal allograft rejection and evaluated the immunological specificity of monoclonal antibodies (mAbs) in preventing allograft rejection in mice.

METHODS

The allografted mice were intraperitoneally injected with 100 micrograms/day of the following mAbs: a control mAb, anti-ICAM-1 mAb, anti-LFA-1 mAb, or a mixture of anti-ICAM-1 and anti-LFA-1 mAbs from 1 day before to 7 days after surgery. The expression of ICAM-1 and LFA-1 molecules in the grafted cornea was studied immunohistochemically. The corneas from a syngeneic donor or a third-party strain were transplanted 4 weeks after the initial keratoplasty onto the mice treated with both anti-ICAM-1 and anti-LFA-1 mAbs.

RESULTS

The allografts treated with anti-LFA-1 mAb alone or both anti-ICAM-1 and anti-LFA-1 mAbs remained transparent for more than 2 weeks, and the survival rate at 8 weeks was 40% in both groups. ICAM-1 was expressed on the mononuclear cells, keratocytes and endothelial cells in the allografts without treatment. The second corneal grafts syngeneic to the initial donor remained transparent at 2 weeks, whereas those from the third party were rejected.

CONCLUSIONS

ICAM-1 and LFA-1 adhesion molecules play a crucial role in the pathophysiology of corneal transplant rejection. The immunosuppressive effects of anti-ICAM-1 and anti-LFA-1 mAbs are highly allospecific. The administration of mAbs to the adhesion molecules represents a new means of suppressing allograft rejection after penetrating keratoplasty.

Idiopathic ventricular fibrillation initiated by a short-coupled ventricular premature beat

We report the case of a 38-year-old man who had idiopathic ventricular fibrillation (VF) which initiated by abnormally short-coupled ventricular premature beats. VF was successfully prevented by the combination of pilsicainide, propranolol, and verapamil. In particular, the effects of pilsicainide are assumed to exert an important effect in controlling this arrhythmia. Class Ic drugs may be effective for preventing VF initiated by short-coupled VPBs.

Plasma neuropeptide Y is reduced in patients with Alzheimer's disease

Neuropeptide Y (NPY) is demonstrated to be involved in the pathophysiology of Alzheimer's disease, as well as somatostatin. We measured the plasma NPY content in patients with Alzheimer's disease and healthy control subjects (n = 25) by HPLC coupled with radioimmunoassay. The difference in screening pattern of NPY-like immunoreactivity in 50 fractions eluted by HPLC obtained from the plasma peptide-rich fraction between patients with Alzheimer's disease and healthy controls suggested the abnormal metabolism of plasma NPY in patients with Alzheimer's disease. Plasma NPY in patients with Alzheimer's disease was significantly decreased compared with that in healthy controls, which was compatible with the findings obtained from the brain and cerebrospinal fluid and could be involved in the pathogenesis or pathophysiology of Alzheimer's disease.

HPLC/RIA analysis of bioactive methionine enkephalin content in the seizure-susceptible El mouse brain

We previously reported a deficit of methionine enkephalin-like immunoreactivity (ME-LI), in the cerebral cortex, septal area, hippocampus, and striatum and the abnormal metabolism of opioid peptides in the hippocampus and striatum of seizure-susceptible El mice, which are involved in the pathogenesis of seizures. However, these findings suggest that the ME-LI does not necessarily reflect the bioactive methionine enkephalin (ME). Herein, we measured the biologically active peptide, ME excluding cross-reactive substances by using HPLC coupled with radioimmunoassay to clarify the abnormal function of enkephalinergic neurons in the El mouse brain. The ME content in 25-day-old El mice that had no seizures was significantly decreased in the hippocampus and septal area, as compared with corresponding regions in ddY mice (seizure-nonsusceptible; the mother strain of El). At the age of 50 days when El mice displayed abortive seizures, this content in both stimulated El[s] and nonstimulated El[ns] was significantly reduced in the septal area and cerebral cortex. At the age of 150 days when El mice exhibit tonic-clonic seizures, this content in both El[s] and El[ns] was significantly reduced in the septal area, cerebral cortex and striatum. These findings were generally compatible with our previous findings. This study further supports our hypothesis that a deficit of anticonvulsant endogenous ME, in the cerebral cortex, septal area, and hippocampus of seizure-susceptible El mice play an important role in the pathogenesis of seizures.

[Local cerebral blood flow and glucose metabolism during seizure in spontaneously epileptic El Mice]

Local cerebral blood flow and glucose metabolism were examined in spontaneously epileptic El mice using autoradiography with 125I-IMP and 14C-DG in the interictal phase and during seizure. El (+) mice that developed generalized tonic-clonic convulsions and El (-) mice that received no stimulation and had no history of epileptic seizures were examined. The seizure non-susceptible, maternal strain ddY mice were used as control. Uptake ratios for IMP and DG in mouse brain were calculated using the autoradiographic density. In the interictal phase, the pattern of local cerebral blood flow of El (+) mice was similar to that of ddY and El (-) mice, and glucose metabolism in the hippocampus was higher in El (+) mice than in El (-) and ddY mice, but flow and metabolism were nearly matched. During seizure, no significant changed blood flow and increased glucose metabolism in the hippocampus, the epileptic focus, and no markedly changed blood flow and depressed glucose metabolism in other brain regions were observed and considered to be flow-metabolism uncoupling. These observations have never been reported in clinical or experimental studies of epilepsy. Seizures did not cause large regional differences in cerebral blood flow. Therefore, only glucose metabolism is useful for detection of the focus of secondary generalized seizures in El mice, and appeared possibly to be related to the pathophysiology of secondary generalized epilepsy in El mice.

Reliability and validity of the Japanese version of the Yale-Brown Obsessive-Compulsive Scale

The reliability and validity of the Japanese version of the Yale-Brown Obsessive-Compulsive Scale (JY-BOCS) were determined by 20 raters for 12 Japanese patients with obsessive compulsive disorder at four institutions. Interrater reliability for the total JY-BOCS score was excellent, and the intraclass correlation coefficient was high (ICC = 0.960). Internal consistency was also excellent (Cronbach's alpha = 0.889). Concurrent and discriminant validity of the JY-BOCS was examined by comparing the scores on the JY-BOCS with those on the Maudsley Obsessional Compulsive Inventory (MOCI) and scales for depression and anxiety. A slight correlation was found between scores on the JY-BOCS and MOCI, but no significant correlations were found between scores on the JY-BOCS and those on scales for depression or anxiety.

Metabolic profile of opioid peptides differs in the hippocampus and striatum of seizure-susceptible E1 mice

We previously suggested that a deficit of anticonvulsant endogenous methionine enkephalin, in the cerebral cortex, septal area, hippocampus, and striatum of seizure-susceptible El mice plays a role in the pathogenesis of seizures. To determine whether a hypofunction of enkephalinergic neuron may be due to metabolic abnormalities of opioid peptides in the El mouse brain, we measured methionine enkephalin-like immunoreactivity (ME-LI) of 50 fractions eluted by high performance liquid chromatography obtained from those four regions of the brain of El and seizure-nonsusceptible ddY mice (the mother strain of El mice). We observed the same ME-LI patterns of 50 fractions in the cerebral cortex and septal area in El and ddY mice, whereas exhibited differing ME-LI patterns in the hippocampus and striatum in the two stains. Different ME-LI patterns may imply the difference in the metabolic profile of opioid peptides. Thus, an abnormal metabolism of opioid peptides in the hippocampus and striatum of the El mouse may be involved in the pathogenesis of seizures.

D2 receptors in the ventrolateral striatum are involved in feeding behavior in rats

To study the role of dopamine D1 and D2 receptors in the ventrolateral striatum in feeding behavior, a D1 receptor agonist (CY 208-243), a D1 receptor antagonist (SCH 23390), a D2 receptor agonist (quinpirole), and a D2 receptor antagonist [(-)-sulpiride] were perfused via a microdialysis probe into the ventrolateral striatum of rats fasted for 22 h. Then the rats were allowed to feed freely for 6 h. Sulpiride perfusion at a high concentration suppressed food and water intake significantly, whereas dopamine release and the levels of DOPAC and HVA were increased at all concentrations. In contrast, quinpirole perfusion at a high concentration increased food intake by 41%. Dopamine release and the levels of DOPAC and HVA were decreased at all concentrations. On the other hand, neither CY 208-243 nor SCH 23390 changed food intake or dopamine release, but both drugs decreased water intake. These results suggest that D2 receptors in the ventrolateral striatum have a more important role than D1 receptors in the feeding behavior of rats.

Full active baculovirus-expressed human monocyte chemoattractant protein 1 with the intact N-terminus

The Sf-9 insect cells infected with a recombinant baculovirus integrated with a cDNA encoding human monocyte chemoattractant protein-1 (MCP-1) produced three different MCP-1s, which were isolated by reverse-phase HPLC as 13kDa, 14kDa, and 15kDa bands on SDS-PAGE. The heterogeneity between these MCP-1s was ascribed to the different degree of O-glycosylation with Gal beta 1-3GalNAc beta 1-Ser/Thr, while the 13kDa was regarded as carbohydrate-free. The integrity of the N-termius was confirmed by the amino acid sequence analysis. Each MCP-1 isolated showed equipotent monocyte chemotactic activity, which was rather higher than that of the E. coli-derived one.

Effects of bifemelane hydrochloride on plasma neuropeptide Y, 3-methoxy-4-hydroxyphenylethylene glycol and 5-hydroxy-indole acetic acid concentrations in patients with cerebral infarction

Bifemelane hydrochloride (BH) is widely employed in Japan in the treatment of cerebral infarction patients with depressive symptoms and its antidepressant action is considered to be caused by the normalizing effects of neurotransmitters. The relationship between the normalizing effects of neurotransmitters of BH and the depressive state of patients with cerebral infarction was examined. BH 150 mg/day was administered for three months to 13 cerebral infarction patients with depressive state. We measured the plasma neuropeptide Y (NPY), 3-methoxy-4-hydroxyphenylethylene glycol (MHPG) and 5-hydroxy-indole acetic acid (5-HIAA), and assessed the depressive symptoms using the 21-item Hamilton's Rating Scale for Depression (HRSD) before and after administration of BH. After treatment, the plasma NPY concentration was significantly increased, the plasma MHPG concentration and total score of HRSD were significantly decreased, and the plasma 5-HIAA concentration showed no changes. These findings suggest that the antidepressant effect of BH is caused by the normalizing effects of NPY and noradrenalinergic neurons.

Serum hepatocyte growth factor levels in patients with chronic renal failure

The serum levels of hepatocyte growth factor (HGF) were determined in chronic renal failure (CRF) patients. Nondialysis patients with renal insufficiency had significantly higher serum HGF than normal subjects (0.34 +/- 0.10 ng/ml, n = 21 vs. 0.19 +/- 0.05 ng/ml, n = 15; p < 0.001), and the elevated serum HGF correlated with their serum creatinine levels. Hemodialysis (HD) patients treated for 5-10 years showed higher serum HGF than those receiving HD for 1 year or less (0.45 +/- 0.14 ng/ml, n = 8 vs. 0.33 +/- 0.11 ng/ml, n = 9; p < 0.05). Continuous ambulatory peritoneal dialysis patients also showed elevated serum HGF levels comparable to those of HD patients. There was no difference in serum HGF levels in HD patients with or without acquired cystic disease of kidney. Consequently, serum HGF is elevated in CRF, which may be attributed to the increased production of HGF in response to the chronic renal injury, the effect of heparin, or reduced removal of serum HGF in CRF patients.

Use of immobilized histidine in assay for endotoxin in patients with liver disease

The Limulus amebocyte lysate (LAL) test has the disadvantage of being influenced by various inhibitors and activators. We have developed a method for the LAL reaction that involves the specific adsorption and isolation of endotoxin using a membrane filter unit and immobilized histidine; in this present study we used the method to measure endotoxin in the plasma of patients with acute or chronic liver disease. The adsorbed endotoxins are separated from LAL-inhibitors or -activators by the membrane filter unit, and their activity is directly assayed with the LAL reagent in a filter cup without any inhibition or activation. The study population consisted of 23 subjects, 3 with fulminant hepatitis and 20 with cirrhosis (9 with esophageal varices and 11 without). All 3 (100%) of the samples of plasma from patients with fulminant hepatitis were positive for endotoxin, as were the samples of 7 (78%) of the 9 patients with cirrhosis and esophageal varices, and 2 (18%) of the 11 patients with cirrhosis but without such varices. The results suggested that this method appears to be useful for assaying the concentration of endotoxin in patients with fulminant hepatitis or cirrhosis of the liver.

[Multivariate analysis of risk factors of rejection in penetrating keratoplasty]

In order to evaluate preoperative risk factors that affect the incidence of endothelial rejection after penetrating keratoplasty, we performed statistical analysis on 571 consecutive cases who had been followed at the University of Tokyo Hospital for at least one year. We applied a logistic regression model (multiple variate analysis) to determine the significance of the association between the preoperative factors and the incidence of rejection. We identified four preoperative risk factors of endothelial rejection in a year as follows: the extent of corneal vascularization, failed previous graft continuous sutures, and preoperative corneal endothelial damage. When the rejection cases were divided into an early group that suffered rejection within 3 months and a late group that suffered rejection after 6 to 12 months, young patients were likely to suffer rejection in the early postoperative period.

[Statistic evaluation of prognostic risk factors in penetrating keratoplasty using Cox multiple regression model]

Preoperative risk factors that may influence the prognosis in penetrating keratoplasty were statistically analyzed on 698 consecutive eye that had been operated on at the University of Tokyo Hospital. A Cox multiple regression model (proportional hazards models) was constructed with simultaneous consideration of follow-up periods and prognostic factors. Six preoperative risk factors were identified: corneal endothelial damage, the presence of anterior synechiae, glaucoma, older donor age, the area of vascularization, and aphakia or pseudophakia. Simulations of the prognosis were attempted using the significant factors.

cDNA cloning and functional expression of a human monocyte chemoattractant protein 1 receptor

A novel human G-protein-coupled seven-transmembrane-type receptor gene, 24-1, has been cloned from THP-1 cells. The 24-1 was 56% and 34% identical to the macrophage inflammatory protein-1 alpha (MIP-1 alpha) receptor and the interleukin-8 (IL-8) receptors at the amino acid level, respectively. To examine the ligand specificity of the receptor, we have established a stable transfectant of this gene with human kidney 293 cells. Monocyte chemoattractant protein-1 (MCP-1) induced a rapid increase of Ca++ influx in the 24-1-transfectant, while other C-C chemokines tested did not. This indicates that the 24-1 encodes the human MCP-1 receptor.

Relationship between endotoxin antibody levels and portal systemic shunt evaluated by per-rectal portal scintigraphy

The reasons for the high frequency of endotoxaemia in cirrhosis, whether poor liver function or abnormal portal circulation, are not known. Accurate measurement of endotoxin itself is difficult. Instead, in this study an enzyme-linked immunosorbent assay was used to measure levels of IgA, IgG and IgM antibodies to endotoxin in patients with chronic liver disease and underlying hepatic viral infection. The relationships between the results and clinical symptoms or the presence of a portal systemic shunt were investigated. The median level of IgA antibodies was not different in patients with chronic hepatitis and those with cirrhosis, and the same was found for IgM, but the median level of IgG antibodies was significantly higher in the patients with cirrhosis. When patients with cirrhosis were grouped by the presence or absence of ascites or hepatocellular carcinoma, no significant difference was observed in any of these antibody levels. However, in cirrhotic patients with varices, the level of IgG antibodies to endotoxin was significantly higher than in patients without varices. For evaluation of the portal systemic shunt, the per-rectal portal shunt index was calculated. There was a significant correlation (R = 0.431, P < 0.001) between the per-rectal portal shunt index and the level of IgG antibodies to endotoxin. That is, the degree of abnormality in the portal haemodynamics was correlated with the level of IgG antibodies to endotoxin in patients with liver disease.

Endogenous methionine enkephalin may play an anticonvulsant role in the seizure-susceptible El mouse

After the intracisternal injection of three protease inhibitors which prevent the degradation of methionine enkephalin (amastatin, Des-Pro2-bradykinin, and phosphoramidon) and a mixture of these protease inhibitors, we investigated the effect on convulsive seizures in the seizure-susceptible El mouse. We also measured the cerebral methionine enkephalin content by high-performance liquid chromatography coupled with radioimmunoassay. Protease inhibitors significantly decreased both the incidence of seizures and the seizure score in El mice in a dose-dependent manner. This anticonvulsant effect was reversed by naloxone (2 mg/kg, sc). The cerebral methionine enkephalin content increased significantly after the administration of protease inhibitors in comparison with saline injection. These findings suggest that it was not protease inhibitors but instead increase of endogenous methionine enkephalin that reduced the incidence of seizures and the seizure score in El mice. Together with our previous data, the present findings support our hypothesis that a deficit in anticonvulsant endogenous methionine enkephalin is involved in the pathogenesis of seizures in the El mouse.

A single-blind comparison of bromperidol and sulpiride in hospitalized schizophrenics

Fourty-five schizophrenic inpatients were randomly assigned to bromperidol or sulpiride in an 8 week single-blind clinical trial. No statistically significant differences were observed for final global improvement rating. Regarding BPRS items and compared to sulpiride, bromperidol was particularly effective to relieve emotional withdrawal and hallucinatory behavior, although the only significant between group difference was in favour of sulpiride for improvements of somatic concern. No significant differences were observed for all PES items, although sulpiride was found more effective for hypochondriasis and neurotic complaint as was bromperidol for hallucination and disturbance of self-conscious. The rate of side-effects and abnormal laboratory test results were comparable in the two groups. They were not severe enough to require termination of administration. Bromperidol and sulpiride are concluded to have different clinical profile in the treatment of schizophrenic hospitalized patients.

[Analysis of the effect of PC-IOL implantation on intraocular pressure control in glaucoma eyes using the life-table method]

Cataract extraction and posterior chamber intraocular lens (PC-IOL) implantation were carried out in 21 primary angle glaucoma (POAG) and 26 primary angle closure glaucoma (PACG) eyes in which preoperative intraocular pressure (IOP) was well controlled with medication. The postoperative IOP on the first postoperative day was significantly higher than the preoperative level in POAG eyes, while no significant difference was seen in PACG eyes. The postoperative IOP was significantly lower than the preoperative level at 3 and 6 months postoperatively in POAG eyes and at 1-12 months postoperatively in PACG eyes. Medication did not differ significantly pre- and postoperatively. In 64 +/- 11% (SE) of POAG and 63 +/- 15% of PACG the status of IOP control did not worsen at 2 years. Overall, 70% of the eyes the status of IOP control improved postoperatively, and this was maintained for 2 years in 44 +/- 12%. The present result implies that in primary glaucoma, PC-IOL implantation surgery does not need to be combined with glaucoma surgeries when the IOP was satisfactory controlled and the stage of disease was not advanced.

[Combined posterior chamber intraocular lens implantation and trabeculectomy--a life-table analysis of postoperative clinical course]

Postoperative courses of 68 eyes of 58 glaucoma patients who underwent posterior chamber intraocular lens implantation combined with trabeculectomy were studied retrospectively. The visual acuity was 0.5 or better in 66% of the eyes at 3 months postoperatively. The average intraocular pressure (IOP) was below 15 mmHg till 16 months postoperatively. An analysis of the postoperative course using the life-table method of Kaplan-Meier revealed that the probability of successful IOP control with medication was 83% at 18 months and 47% without medication. The subjects aged 75 years or older showed significantly higher success probability than those younger than 75 years, while types of glaucoma, the preoperative IOP control, location of conjunctival or sclerocorneal incision, postoperative 5-fluorouracil (5-FU) injections or surgical intervention on the iris had no significant effects on the probability of successful IOP control. The probability of subsistence of functional filtering bleb was 24% at 18-month follow-up, on which postoperative administration of 5-FU of 35 mg or more had a favorable effect.

[Intraocular lens implantation after glaucoma filtering surgery--time course of changes in intraocular pressure control and filtering blebs]

Cataract extraction and intraocular lens (IOL) implantation were carried out in 45 glaucomatous eyes that had undergone glaucoma filtering surgery. Of these, 37 eyes had primary glaucoma, 2 eyes capsular glaucoma, and 6 eyes secondary glaucoma. The visual acuity after IOL implantation was 0.5 or more in 29 eyes (64%) but in 10 eyes (22%) acuity was 0.1 or less because of advanced optic nerve head damage. To analyze affects of IOL implantation on intraocular pressure (IOP) control and functioning of the filtration bleb in 39 eyes of primary or capsular glaucoma, a life-table analysis with the Kaplan-Meier method was performed. The probability that IOP control does not worsen at 2 years was 43 +/- 7% (SE) in 21 eyes without pre-operative ocular hypotensive medication, 56 +/- 16% in 18 eyes with pre-operative ocular hypotensive medication, 47 +/- 12% in 26 eyes where functioning filtering bleb existed pre-operatively. The probability that the filtering bleb survives 2 years post-operatively was 44 +/- 11%. The present results imply that intensive management of post-operative inflammation and careful IOP follow up are imperative in eyes in which IOL implantation was indicated after undergoing filtration surgery.

Effects of morphine and D-Ala2-D-Leu5-enkephalin in the seizure-susceptible El mouse

Opioid agonists were used to investigate the modulation of seizures in the seizure-susceptible El mouse. Morphine and D-Ala2-D-Leu5-enkephalin (DADLE) were injected subcutaneously or intracisternally as prototypic agonists for mu and delta opioid receptors. Systemic or intracisternal injection of both morphine and DADLE decreased the incidence of seizures and the seizure score in El mice in a dose-dependent manner. The anticonvulsant effects of morphine and DADLE were reversed by naloxone (2 mg/kg, s.c.). This implies that opioid agonists have anticonvulsant properties which are mediated by mu and delta opioid receptors. In conclusion, a deficit in endogenous opioid peptides, which act as anticonvulsants may play a significant role in the etiology or pathophysiology of seizures in the El mouse.

Sequence complexity of polyadenylated RNA from seizure-susceptible El mouse brain polysomes

The hybridization kinetics in the complementary DNAs (cDNA) to polyadenylated messenger RNA (mRNA) in the brain of seizure-susceptible El mice were examined to elucidate the correlation between seizure susceptibility and genetic expression. Homologous and heterologous saturation hybridizations indicated that cDNA of seizure-nonsusceptible ddY mice hybridized with less mRNA in seizure-experienced El(+) or seizure-nonexperienced El(o) mice than that in ddY mice, cDNA of El(+) mice hybridized to a lesser extent with mRNA of El(o) mice than that of ddY or El(+) mice, and no difference was observed with cDNA hybridization results of El(o) mice to individual mRNAs of ddY, El(+) or El(o) mice. The results suggest that some sequences found in mRNA of ddY are lacking in both El strains and are responsible for the inbred predisposition, while those present in El(+) mRNA but missing in El(o) may associate with seizure susceptibility, since common sequences are present in the mRNA of those groups of animal. The sequence diversity among the 3 groups of mice was mainly observed with the rare class of mRNA. Molecular cloning of the cDNA corresponding to this class of mRNA found in the El(+) mice would clarify the gene expression in the brains of epileptics.

[The effect of conservative and surgical management for secondary hyperparathyroidism and their problems]

We compared the effect of conservative treatment with that of surgical treatment after applying them on secondary hyperparathyroidism patients (2nd HPT) in order to study the application of surgery on 2nd HPT patients. We selected the test subject of 39 maintenance dialysis patients with complications of 2nd HPT. The conservative treatments were; elcitonine administration (40 u x 3/W) (group 1), ipriflavon administration (200 mg x 3/day) (group 2), and pulse treatment (1.25 (OH)2D3 6 micrograms/W) (group 3). For surgical treatment, we adopted total parathyroidectomy with auto-transplantation into the arm (PTX). The transition of serum parathyroid hormone (PTH-C), alkali-phosphatase (ALP), bone scintigraphy of every 6 months, and change of bone mineral content (BMC) were compared to judge the effects of treatments. We measured 1/3, 1/6 radial region with single photon absorptiometry (SPA) and L3 region with dual photon absorptiometry (DPA) to obtain BMC. We were forced to transfer the patients in groups 1 and 2 (conservative treatment) to pulse treatment or PTX as 12 months later they showed increase in serum PTH-C, ALP and significant drop (P less than 0.05) in BMC average change rate (1/3). In group 3 of pulse treatment, though significant decrease in serum ALP (P less than 0.01) was detected for 10 cases out of 12, serum PTH-C was either unchanged or increased for 4 cases with the value of more than 30 ng/ml. Furthermore the average change rate of BMC stayed at the same level.(ABSTRACT TRUNCATED AT 250 WORDS)

Exophthalmos in myelodysplastic syndrome

A case of myelodysplastic syndrome (MDS) who suffered alternating proptosis was reported. A 57-year-old Japanese man with MDS developed acute painful left proptosis with eyelid edema, conjunctival injection, visual disturbance, and restriction of eye movements. This lasted for 3 weeks. Computerized tomography (CT) showed swelling of the lateral and medial rectus muscles and the optic nerve, as well as a retrobulbar mass. Later, a similar painful right proptosis with severe conjunctival chemosis developed. CT showed only bilateral mild optic nerve swelling. The visual acuity of the right eye decreased to null even after remission of the proptosis. The patient died due to myocardial infarction and underwent autopsy. The right optic nerve stroma was found to be increased over that of the left. Cellular infiltration was noted in the left optic nerve and the retrobulbar connective tissue. This self-limiting and relapsing proptosis was apparently related to MDS. This is only the second MDS case with such severe ophthalmological symptoms reported in the literature.

Detection of endotoxin antibody in long-term dialysis patients

Endotoxins are often seen in dialysate. They are derived from Gram-negative bacteria especially Pseudomonas, E. coli and Serratia. Endotoxins are large-molecular-weight substances with an average molecular weight of 10(8). These large units can be divided into subunits down to a molecular weight of 10,000 which are thought to pass through dialyzer membranes. To investigate this, endotoxin antibody levels were measured in two groups of patients on chronic regular hemodialysis, a low-flux group using cellulosic membrane dialyzers (cuprophan and cuproammonium rayon (CAR) and a high-flux group using synthetic polymer membrane dialyzers (PMMA, EVAL). Using an ELISA based on standard endotoxin antibodies the percentages of patients in the low flux group with endotoxin antibodies were 26.9% with Cuprophan and 25% with CAR, not significantly different from a normal control group. In the PMMA and EVAL groups, it was 53.6% and 68.4% respectively. Back filtration of dialysate into blood is understood as the main reason for the entry of endotoxin in patients treated with high-flux dialyzers.

Novel endotoxin adsorbing materials, polymyxin-sepharose and polyporous polyethylene membrane for removal of endotoxin from dialysis systems

In order to remove contaminated endotoxin from dialysis systems, we prepared and investigated two novel endotoxin adsorbing materials, Polymyxin-Sepharose (PxSeph) and polyporous polyethylene hollow fiber membrane (EHF). PxSeph was prepared by covalently immobilizing polymyxin B on Sepharose 4B beads by CNBr coupling method. It adsorbed various endotoxins with a high affinity constant and could effectively remove endotoxin from aqueous solution and human plasma. EHF also removed endotoxins from contaminated water by filtration through EHF modules, and its adsorption nature was demonstrated. Both PxSeph and EHF are stable in physiological conditions and proved to be useful adsorbents for removal of contaminated endotoxin from the hemodialysis systems.

Developmental and regional alteration of methionine enkephalin-like immunoreactivity in seizure-susceptible E1 mouse brain

Methionine enkephalin-like immunoreactivity (ME-LI) in the brain of El mice (seizure-susceptible strain) was measured by radioimmunoassay (RIA) to elucidate the relation between seizures and the opioid system. The lyophilized supernatants of tissue extracts were subjected to ME RIA. The concentration of ME-LI in 25-day-old El mice that had no seizures was significantly decreased in the hippocampus. At the age of 50 days when El mice displayed abortive seizures, the levels of ME-LI in both El(+) and nonstimulated El(o) mice were also significantly reduced in the hippocampus and septal area. It was further shown that the ME-LI concentrations in both 150-day-old adult El(+) during interictal periods and El(o) mice were markedly decreased in the cerebral cortex, septal area, and striatum, as compared with the corresponding regions in ddY mice (seizure-nonsusceptible strain; the mother strain of El). The decrease of ME-LI in the El mouse brain was generally compatible with our previous findings concerning the up-regulation of opioid delta receptors in this species. These results suggest that the reduction of ME-LI in the El mouse brain is not due to convulsions, but could be associated with the pathogenesis of seizure diathesis and seizure manifestations in the El mouse.

Correlation between blood prostaglandins, plasma lipids and atherosclerosis in dialyzed patients

The correlations between the degree of atherosclerosis, plasma prostaglandins (PGs) and plasma lipids were examined in maintenance hemodialyzed patients with and without diabetes mellitus. The degree of atherosclerosis was evaluated by pulse wave velocity (PWV) of the aorta. Plasma PGs were radioimmunoassayed. PWV was significantly higher in hemodialyzed patients compared to sex- and age-matched healthy controls. PWV correlated with the plasma thromboxane A2 (TXB2) level and TXB2/6-keto-PGF1 alpha ratio in hemodialyzed patients, without a significant difference between the diabetic and nondiabetic groups. The plasma lipid profile was type IV of the WHO classification in both the diabetic and nondiabetic groups, and PWV did not correlate with these lipid abnormalities. Though not significantly, the decreases in plasma PGE2 and 6-keto-PGF1 alpha and the increase in TXB2 correlated with the degree of type IV hyperlipidemia. The results suggest that plasma PG abnormalities might correlate with the degree of atherosclerosis in hemodialyzed patients.

Alterations in polyadenylic acid-containing messenger RNA synthesis of brain polysomes after seizures of seizure-susceptible E1 mice

The effect of seizures on synthesis of the polyadenylic acid (poly(A]-containing messenger RNA (mRNA) isolated from brain polysomes in a genetically seizure-susceptible E1 mouse was studied in vivo. The seizure in the E1 mice was induced by tossed-up stimulation. Immediately after the seizure ceased, the labeled orotic acid was injected into the brain. The incorporation rates of labeled orotic acid into poly(A)-containing mRNA isolated from polysomes are represented as the specific radioactivity (SR) (dpm/mg RNA) and the relative specific radioactivity (RSR) (dpm/mg RNA/dpm/mumoles of acid soluble uridine-5'-monophosphate (UMP]. Both the rates were reduced to 70% in SR and 65% in RSR at 1 h after the seizures. This reduction was gradually recovered to the level of interictal E1 mice at 6 h. The seizure-induced alterations are not attributable to the difference in the uridine nucleotide pool because the SR of UMP was not significantly affected by the seizure. The peak of labeled poly(A)-containing mRNA by analysis of gel electrophoresis displaced towards a lower molecular weight at 1 h after the seizures. The RNA showed a higher ratio of AMP and UMP per GMP and CMP in nucleotide composition, implying that this RNA is identical with DNA. These results suggest that the temporary decrease found in cytoplasmic mRNA synthesis induced by the seizures of E1 mice appears to be a result of impaired transcriptional processes in heterogeneous nuclear RNA synthesis and that the smaller mRNA coding for protein associated with seizures is newly synthesized during the postictal period.

Detection of bacteria in dialysate and its antibody in long-term hemodialysis patients

The relationship between endotoxin, which was detected in the dialysate, and incidence of its antibody formation in long-term hemodialysis patients was studied. Bacteria in the dialysate were first obtained, identified, and cultured, and then endotoxin was obtained from the bacteria by extraction with phenol. Using the endotoxin obtained and Escherichia coli J-5 as the antigen, the endotoxin antibody was measured in the serum of long-term hemodialysis patients by enzyme-linked immunosorbant assay (ELISA). It was found that the percentage of endotoxin antibody-positive patients was significantly higher in hemodialysis patients when compared with healthy controls. It was also significantly higher in hemodialysis patients using synthetic polymer membrane dialyzers compared with those using cuprophan membrane dialyzers. These results suggest that endotoxin antibody detected in hemodialysis patients was derived from the dialysate, and that the dialysate must be kept bacteria free, especially in patients using high-flux, highly permeable membrane dialyzers.

Leukocyte tissue-type plasminogen activator activity in dialysis patients

Plasma fibrinopeptide B beta 15-42 was significantly high in undialyzed and hemodialyzed chronic renal failure (CRF) patients, indicating that the fibrinolytic system as well as the coagulation system is stimulated. There are two kinds of plasminogen activators (PA) for the fibrinolytic system: urokinase (UK) and tissue-type PA (t-PA). PA activity of peripheral leukocytes from healthy volunteers, continuous ambulatory peritoneal dialysis (CAPD) patients and hemodialysis (HD) patients was measured and compared. Peripheral leukocyte PA in the euglobulin fraction was purified using zinc-chelate-Sepharose 6B column and Concanavalin A-Sepharose column chromatography. The different PA activity was quantitatively identified by electrophoretic enzymography and was confirmed using antibody against UK and t-PA. PA activity of peripheral leukocytes was significantly higher in HD patients on the cupro-ammonium processing membrane dialyzer than in CAPD patients and healthy volunteers. All PA activity in the three groups was UK, and t-PA was not detected. This suggested that the inflammatory response was continuously induced in HD patients, resulting in the induction of PA activity of the leukocytes and plasma, and that different mechanisms were involved for the synthesis or secretion of UK and t-PA.

Leukocyte Tissue-Type Plasminogen Activator Activity in Dialysis Patients

Plasma fibrinopeptide Bβ15–42was significantly high in undialyzed and hemodialyzed chronic renal failure (CRF) patients, indicating that the fibrinolytic system as well as the coagulation system is stimulated. There are two kinds of plasminogen activators (PA) for the fibrinolytic system: urokinase (UK) and tissue-type PA (t-PA). PA activity of peripheral leukocytes from healthy volunteers, continuous ambulatory peritoneal dialysis (CAPD) patients and hemodialysis (HD) patients was measured and compared.

Peripheral leukocyte PA in the euglobulin fraction was purified using zinc-chelate-Sepharose 6B column and Concanavalin A-Sepharose column chromatography. The different PA activity was quantitatively identified by electrophoretic enzymography and was confirmed using antibody against UK and t-PA. PA activity of peripheral leukocytes was significantly higher in HD patients on the cupro-ammonium processing membrane dialyzer than in CAPD patients and healthy volunteers. All PA activity in the three groups was UK, and t-PA was not detected. This suggested that the inflammatory response was continuously induced in HD patients, resulting in the induction of PA activity of the leukocytes and plasma, and that different mechanisms were involved for the synthesis or secretion of UK and t-PA.

Alteration of opioid receptors in seizure-susceptible El mouse brain

The distribution density of opioid receptors in the brain of El mice (seizure-susceptible strain) was examined to determine the relation between seizures and the opioid system. Saturation curves and Scatchard plots of [3H]2-D-alanine-5-D-leucine enkephalin binding revealed that the opioid delta receptor density in adult El mice during interictal periods was significantly increased in the cerebral cortex, hippocampus, and septal area. It was further shown that the concentration of such receptors in 25-day-old El mice that had no seizures was also significantly increased in the hippocampus and septal area, with no changes in apparent affinities, as compared with in the corresponding regions in ddY mice (seizure-nonsusceptible strain; the mother strain of El). Such up-regulation of opioid receptors in the El mouse brain could result from deficits in endogenous opioid peptides, which could be associated with the pathogenesis of seizure diathesis in the El mouse.

Some properties of protein in synaptosomal fractions from El mouse cerebral cortices

Synaptosomal and TCA insoluble proteins were prepared from the cerebral cortices of El(+) during the interictal periods, El(0) which did not stimulate and convulse at all, the seizure-nonsusceptible ddY mice. Both the proteins analyzed by SDS-PAGE electrophoresis indicated 5 major bands and 20-30 minor bands. In the major bands, 67K protein of the synaptosomal and TCA insoluble proteins in the El(+) mice was significantly lower than those of the ddY or El(0) mice and of the ddY mice, respectively.

Induction of tumouricidal macrophages by MTP-PE: its enhancement by a factor produced spontaneously by tumour cells

Tumouricidal activity of rat alveolar macrophages is induced by MTP-PE in vitro. This tumouricidal activity is enhanced by a factor (tumour cell derived immunostimulating factor, TCIF) contained in tumour cell culture supernatants. TCIF is not species specific, since culture supernatants of rat MADB-200 as well as mouse B16 or Meth A tumour cells showed similar effects on rat alveolar macrophages. TCIF is not produced in cultures of normal cells, e.g. rat embryo cells. TCIF produced by MADB-200 tumour cells is relatively heat-stable and dialyzable. It is destroyed by treatment at pH 2 for 24 hrs. These results suggest that TCIF can participate in macrophage activation and could be of potential therapeutic value.

Correlation between blood prostaglandins and blood pressure in chronic renal failure

Plasma prostaglandins (PGs; PGE2, PGF2 alpha, 6-keto-PGF 1 alpha and TXB2) and plasma renin activity (PRA) were measured in 94 end-stage renal disease (ESRD) patients including 15 undialyzed, 74 maintenance-hemodialyzed and 5 anephric patients, and in 27 healthy controls. In the healthy controls, 6-keto-PGF 1 alpha inversely correlated with age, while TXB2 and the TXB2/6-keto-PGF 1 alpha ratio correlated with age. In the ESRD patients, 6-keto-PGF 1 alpha showed a tendency to decrease with age, and the TXB2/6-keto-PGF 1 alpha ratio significantly correlated with age. The undialyzed group showed significantly higher blood pressure and TXB2 but significantly lower 6-keto-PGF1 alpha compared to the other groups. In the dialyzed group, PGE2 and 6-keto-PGF1 alpha tended to be lower and TXB2 higher compared to the healthy control group. In the dialyzed group, 6-keto-PGF1 alpha correlated inversely with blood pressure independently from PRA. As for PGF2 alpha, it was higher in the undialyzed, dialyzed and anephric groups than in the healthy control group. These results suggested that PGs were involved in blood pressure abnormalities, and that PGI2 played an important role in controlling blood pressure in ESRD patients as one of the depressor factors.