Enzyme immunoassay of immunoreactive progastrin-releasing peptide(31-98) as tumor marker for small-cell lung carcinoma: development and evaluation

Previously, using recombinant human progastrin-releasing peptide (ProGRP)(31-98), we developed a RIA for ProGRP(31-98) and demonstrated that the determination of serum ProGRP(31-98) was a reliable marker for small-cell lung carcinoma (SCLC) (Miyake et al., Cancer Res 1994;54:2136-40). Aiming for a more convenient assay system, we have now developed and evaluated a highly sensitive and specific ELISA for ProGRP(31-98). Only 50 microL of nonextracted serum is needed, and results are obtained in only 2 h. Intraassay and between-day CVs were 1.7-4.6% and 4.2-6.8%, respectively. The log-log calibration curve was linear to 1000 ng/L, and analytical recovery was 91.5-108.7%. The detection limit of this assay, 1.9 ng/L, means that basal concentrations of ProGRP(31-98) were detectable in all healthy subjects. The cutoff value, based on the mean + 3 SD of concentrations in 247 healthy subjects, was set to 45.1 ng/L. Serum concentrations exceeded this value in 18 of 25 SCLC patients, similar to the frequency of increased values found by RIA previously. In contrast, the frequency of increased serum ProGRP(31-98) in patients with nonmalignant pulmonary diseases or non-SCLC was quite low: 0% and 5.0%, respectively. Such results may justify a clinical trial for evaluating this ELISA for the diagnosis and monitoring of SCLC patients.

[Histological examination of the human retina with congenital stationary night blindness]

We report histological findings of the retina from an eye with congenital stationary night blindness. The case was an 82-year-old woman who showed a Schubert-Bornschein type electroretinogram, and whose eye was enucleated due to orbital invasion of paranasal malignant melanoma. The retina had a disorganized outer plexiform layer with displaced nuclei of the outer and inner nuclear layer. There was also outward displacement of the cone nuclei, formation of hyaline and serous drusen, and disorganized retinal pigment epithelium as the histological changes due to aging. The histological abnormality seen in the outer nuclear layer could be responsible for the electrophysiological abnormality in this case.

Concomitant and isolated expression of TGF-alpha and EGF-R in human hepatoma cells supports the hypothesis of autocrine, paracrine, and endocrine growth of human hepatoma

Single and double immunohistochemical staining for transforming growth factor (TGF)-alpha and epidermal growth factor-receptor (EGF-R) was done in order to identify the localization of TGF-alpha and EGF-R in human hepatocellular carcinoma (HCC). Single immunohistochemical staining for TGF-alpha showed immunoreactivity in the cytoplasm of hepatoma cells in 22 of 30 cases of HCC. The localization of TGF-alpha was heterogeneous from HCC cells to HCC cells. In the surrounding regenerative nodules, the hepatocytes were mildly to moderately positive for TGF-alpha. The proliferating bile ductules and peripheral nerves were also immunopositive for TGF-alpha. Single immunohistochemical staining for EGF-R demonstrated a linear localization of EGF-R along the cell membrane of the HCC cells in 21 of the 30 cases of HCC. In the regenerative nodules, the hepatocytes also showed linear staining along the cell membrane. Double staining for TGF-alpha and EGF-R in 12 cases of HCC showed a concurrent localization of TGF-alpha and EGF-R in some hepatoma cells and isolated localization of the two substances of other HCC cells. These combinations either abruptly moved around or intermingled with each other. These immunohistochemical results thus support the theory of an autocrine, paracrine, and endocrine mechanism of TGF-alpha and EGF-R on the proliferation of human hepatocellular carcinoma.

Antioxidant effects of "beta catechin"

The free radical scavenging effect of "beta catechin", an antioxidant preparation containing green tea extract, ascorbic acid, sunflower seed extract, dunaliella carotene and natural vitamin E, was evaluated. Two techniques were used: electron spin resonance (ESR) spectrometry to measure radical-scavenging activity, and measurement of its effect on iron-induced lipid peroxidation in brain. A 0.05% solution of "beta catechin" completely scavenged 1,1-diphenyl-2-picrylhydrazyl (DPPH) radicals (6.1 x 10(15)spins/ml). A 10% solution of "beta catechin" completely scavenged superoxide (4.2 x 10(15) spins/ml) generated by the hypoxanthine-xanthine oxidase system. An undiluted solution of "beta catechin" scavenged about 90% of hydroxyl radicals (3.5 x 10(15) spins/ml) generated by the Fenton reaction. "beta catechin"s effect on the accumulation of thiobarbituric acid-reactive substances (TBARS) was evaluated from tissue obtained from the ipsilateral cortex of FeCl3-induced epileptic rats. Oral administration of "beta catechin" (1 or 2ml/kg body weight) both inhibited TBARS formation and increased the activity of superoxide dismutase (SOD) in the ipsilateral cortex 30 min after iron-salt injection into the left sensory motor cortex. These data suggest that "beta catechin" has an antioxidant effect and may have a prophylactic effect against aging and other neurological diseases related to free radical mechanisms.

[A case of tropical eosinophilia associated with pleural effusion]

A 52-year-old man was admitted to Keio University Hospital for determination of the etiology of a bilateral pleural effusion associated with marked eosinophilia (10200 cells/mm3). He had been in Vietnam for three years and had returned to Japan in May 1993. He was suffering from tropical eosinophilia, as clearly indicated by eosinophilia, elevation of serum IgE level (708 IU/ml), the presence of anti-dirofilarial antibodies, and the absence of microfilaria in the blood. The pleural effusion was an exudate and 51% of the cells in the effusion were eosinophils. In the effusion, no parasites were detected but anti-dirofilarial antibodies were found (the titer was as high as that in the serum). Diethylcarbamazine was given, and a steroid had to be superimposed because of wheezing. These treatments successfully reduced the bronchoconstriction, eosinophilia and accumulation of pleural effusion. Tropical eosinophilia has generally been thought not to be associated with pleural effusion. This is only the third case report of tropical eosinophilia with authentic pleural effusion.

Enzyme immunoassay of immunoreactive progastrin-releasing peptide(31-98) as tumor marker for small-cell lung carcinoma: development and evaluation

Previously, using recombinant human progastrin-releasing peptide (ProGRP)(31-98), we developed a RIA for ProGRP(31-98) and demonstrated that the determination of serum ProGRP(31-98) was a reliable marker for small-cell lung carcinoma (SCLC) (Miyake et al., Cancer Res 1994;54:2136-40). Aiming for a more convenient assay system, we have now developed and evaluated a highly sensitive and specific ELISA for ProGRP(31-98). Only 50 microL of nonextracted serum is needed, and results are obtained in only 2 h. Intraassay and between-day CVs were 1.7-4.6% and 4.2-6.8%, respectively. The log-log calibration curve was linear to 1000 ng/L, and analytical recovery was 91.5-108.7%. The detection limit of this assay, 1.9 ng/L, means that basal concentrations of ProGRP(31-98) were detectable in all healthy subjects. The cutoff value, based on the mean + 3 SD of concentrations in 247 healthy subjects, was set to 45.1 ng/L. Serum concentrations exceeded this value in 18 of 25 SCLC patients, similar to the frequency of increased values found by RIA previously. In contrast, the frequency of increased serum ProGRP(31-98) in patients with nonmalignant pulmonary diseases or non-SCLC was quite low: 0% and 5.0%, respectively. Such results may justify a clinical trial for evaluating this ELISA for the diagnosis and monitoring of SCLC patients.

[Trial of a small image network system in a radiology department of an university hospital]

This paper describes the construction of an image network system in Shinshu University Hospital, and some of its current issues and advantages. Our discussion is based on our experience with a PACS system. SAIPACS, which was installed in 1990 for use in clinical conferencing and pre- and post-graduate education, and with a new CT and MRI network, which was subsequently introduced in 1993. The SAIPACS interconnects eight digital imaging modalities, including CT, MRI, XTV-DR (including digital tomosynthesis), FCR, nuclear medicine (RI), DSA, US, and a film digitizer (FD), with a workstation. Transmission time from the magnetic disk of each imaging modality to the SAIPACS image disk is not rapid enough. Therefore, we need to select images for transfer that are pertinent to our specific purpose, to complete image transmission within a practically acceptable period of time. The new CT/MRI network is composed of two CT units, two MRI systems, an image processing unit and a Universal Gateway. It provides faster image transmission than the SAIPACS system, because there is no need to reform image data to send them in a reversible compressed form. A versatile network system connected to the SAIPACS and CT/MRI network enables digital image data to be processed and edited and images to be transferred back to SAIPACS for clinical or educational use.

Increased number of circulating HTLV-1 infected cells in peripheral blood mononuclear cells of HTLV-1 uveitis patients: a quantitative polymerase chain reaction study

AIMS

This study aimed to characterise the status of viral infection in patients with HTLV-1 uveitis (HU) by quantifying the circulating HTLV-1 infected cells in the peripheral blood.

METHODS

Genomic DNA samples of peripheral blood mononuclear cells (PBMC) were obtained from 25 patients with HU, 14 patients with tropical spastic paraparesis/HTLV-1 associated myelopathy (TSP/HAM), and 21 asymptomatic carriers of HTLV-1. Quantitative polymerase chain reaction (PCR) of the gag region of HTLV-1 provirus DNA was performed on these DNA samples. To confirm the PCR, genomic Southern blot hybridisation was performed to identify integrated HTLV-1 provirus. This procedure detected a few percent of HTLV-1 infected cells in the PBMC.

RESULTS

Most of the HU patients had a significantly increased number of circulating HTLV-1 infected cells (mean (SD) 3.84% (4.45%) of the PBMC), whereas the percentage of infected cells in most asymptomatic carriers was less than 1% (0.54% (1.11%)). Most of the TSP/HAM patients also had a relatively high percentage (11.63% (7.67%)). The differences among these three groups were highly significant by the Mann-Whitney U test.

CONCLUSION

The results suggested that the increase in the number of HTLV-1 infected cells is one base for the development of inflammatory HU lesions, as it is for TSP/HAM.

In vitro and in vivo antibacterial activities of Q-35, a novel fluoroquinolone

Q-35, a new fluoroquinolone, was evaluated for its in vitro and in vivo antibacterial activities. In vitro antibacterial activity against gram-positive bacteria was almost equal to that of sparfloxacin or tosufloxacin, but its activity against gram-negative bacteria was 2 times or more lower than that of other quinolones tested. In experimental septicemia, the in vivo activity of Q-35 reflected its in vitro antibacterial activity. In respiratory tract infections with Streptococcus pneumoniae TMS-3 in mice, Q-35 showed a therapeutic effect similar to sparfloxacin and tosufloxacin. Q-35 showed almost the same activity as that of ofloxacin in mice with pyelonephritic infection due to Escherichia coli TMS-3. The peak levels of Q-35 in murine serum, lungs and kidneys after a single oral administration were intermediate compared to those of tested quinolones.

The role of peritoneal stromal cells in the survival of sIgM+ peritoneal B lymphocyte populations

Peritoneal (PE) B cells, a large fraction of which belong to the B-1 subset (i.e., the CD5+ B cell lineage), exhibit unusual growth and/or survival characteristics. To evaluate if these characteristics reflect intrinsic properties of PE B cells or the support provided by a potentially unique peritoneal microenvironment, B cells from various organs were cultured on PE stromal cell monolayers. It was determined that sIgM+ PE B cell populations survive for notably long periods of time (at least 4 weeks) when cultured with PE stromal cells. Contact of PE B cells with stromal cell monolayers optimized B cell survival. Although expressing a similar spectrum of adhesion molecules as peritoneal stromal cells, splenic and bone marrow stromal cells were significantly inferior at supporting PE B cells. Increased survival of PE B cells was characterized by a significant but transient increase in proliferation and by an increase in the percentage of B220/CD45high/CD5+ PE B cells. PE stromal cell support of B cell populations did not extend to all B or even to all B-1 cell populations since survival of splenic B cells, only a minority of which belong to the B-1 lineage, or thymic B cells, a majority of which belong to the B-1 lineage, was not enhanced by culture on PE stromal cells. Results demonstrate: (a) a system for relatively long-term maintenance of mature B cells, (b) that the growth/survival of PE B cells is preferentially supported by PE stromal cells, and (c) that growth on PE stromal cells is a characteristic of peritoneal B cells but not necessarily of splenic B cells or B-1 cells from other organs. The suggestion that the local microenvironment contributes to unusual growth, survival, or anatomic distribution of B-1 cells is discussed.

Influence of various immunosuppressive agents on the occurrence of endogenous bacteraemia in mice

The influence of six immunosuppressive agents on the occurrence of endogenous bacteraemia in mice was evaluated. The mortality rates in conventional ddY mice given cyclophosphamide (CY), fluorouracil (5-FU), methotrexate (MTX), cisplatin (CDDP) or FK-506 intraperitoneally, or dexamethasone (DXM) subcutaneously were 70, 100, 100, 100, 0 and 0%, respectively. Pseudomonas aeruginosa was isolated from 70% of mice treated with CY but from only 10% of mice treated with 5-FU and 30% treated with MTX. Enterobacteria were isolated from 90% of mice treated with 5-FU. Specific-pathogen-free (SPF) mice fed P. aeruginosa were also treated with these agents. All mice in the CY, 5-FU, MTX and CDDP groups died whereas mice treated with DXM and FK-506 showed 20% and 0% mortality, respectively. Pure cultures of P. aeruginosa were obtained from all of the mice treated with CY. Polymicrobial bacteraemia with P. aeruginosa and enterobacteria occurred in 5, 25, 5 and 5% of mice treated with 5-FU, MTX, CDDP and DXM, respectively. Enterobacterial bacteraemia was observed in 70% of mice treated with CDDP and in 5% of the DXM group. Different types of bacteraemia were induced by different immunosuppressive agents. The mechanism of immunosuppression may affect the frequency of bacteraemia and the causative organism.

Exogenously expressed granulocyte colony-stimulating factor (G-CSF) receptor on K562 cells can transduce G-CSF-triggered growth and differentiation signals

Human granulocyte colony-stimulating factor (G-CSF) receptor cDNA was introduced into the erythroleukemic cell line K562, which normally does not express the receptor, using lipofection transfection of a G-CSF receptor expression plasmid vector. Transfected cells expressed the receptor with a dissociation constant of 130 pmol/L, and a maximum of 11,800 binding sites per cell. Culture of G-CSF receptor-expressing cells (GR-K562) in the presence of G-CSF enhanced DNA synthesis and a stimulation index of 4.61 was obtained in a 3H-thymidine uptake assay. Furthermore, flow cytometric studies revealed induced expression of CD11b (29% from 7%), and enhanced expression of CD13 (57% from 27%) on GR-K562 cultured in the presence of G-CSF. Our findings indicate that the exogenously expressed G-CSF receptor can deliver signals and function efficiently on these immature cells on which the receptor is not normally expressed, which suggests the presence of intact intracellular signal transduction pathways that can be used by the ectopically expressed receptor.

Identification of DNA-binding proteins changed after induction of sporulation in Bacillus cereus

DNA-binding proteins were extracted from both exponentially growing cells of Bacillus cereus ts-4 and cells that were induced to sporulate at different stages of chromosome replication, by using a double-stranded B. cereus ts-4 DNA-cellulose column. Two-dimensional electrophoresis of the proteins found that the amounts of 17 proteins changed drastically after induction of sporulation at all the stages. For 8 of those proteins, the largest or the smallest amount was found in the cells which were induced to sporulate 40 min after the initiation of chromosome replication, the sensitive stage for sporulation. The N-terminal amino acids of 6 proteins among the selected proteins were sequenced. The sequence obtained from a 59-kDa protein had sequence similarity (> 45%) to GroEL from several bacterial species. In addition, the sequences from 76- and 52-kDa proteins matched deduced amino acid sequences of a Mycobacterium leprae gene showing homology to the bacteria atp operon and the B. subtilis guaB for IMP dehydrogenase, respectively.

Mesothelial cyst of the adrenal gland

A case of mesothelium-lined cyst of the adrenal gland is reported. Although more than 300 adrenal cysts have been reported in the literature, epithelial cell-lined cysts are rare and comprise only 9% of the cases. An adrenal cyst was found, the lining cells of which had features consistent with mesothelial cells. The inner surface of the cyst was lined by a single layer of cuboidal cells, which showed alcian blue positive cellular outline. Immunohistochemically, the lining cells were positively stained for keratin, epithelial membrane antigen and CA-125. Electron microscopic examination revealed many long complex microvilli and desmosomes in the lining cells. There was a basal lamina beneath the cell layer. These morphological and immunohistochemical findings indicated that the lining cell is derived from mesothelium.

[Neuroleptic malignant syndrome associated with the syndrome of inappropriate secretion of antidiuretic hormone]

We reported a case of neuroleptic malignant syndrome (NMS) associated with the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). A 71-year-old woman, who had been diagnosed as hypertension and multiple cerebral infarction, was given sulpiride 150 mg daily for depressive state. Three days after started sulpiride, she developed fever, sweating, difficulty of movement and was admitted to the hospital. The white blood cell count rose to 16,300/mm3 and serum creatine kinase (CK) to 3,063 IU/L. Two days later CK rose to 20,050 IU/L regardless of stopping the drug, so she was transferred to our hospital for further investigation. On admission, it was the 6th day from the onset, she was mute and akinetic accompanied by muscle pain and rigidity in extremities. Serum CK was 1,831 IU/L, Na 122 mEq/L, osmolality 244 mOsm/kg, plasma antidiuretic hormone (ADH) level 6.5 pg/ml and urine Na was 101 mEq/L, osmolality 467 mOsm/kg. Renal and adrenal functions, plasma renin activity were normal. From the history, course and these data, diagnosis of NMS associated with SIADH was made. Intravenous sodium (130-200 mEq/day) and fluids (1,000-1,200 ml/day) were carefully infused. She became active, muscle pain disappeared and rigidity, akinesia decreased. CK, serum Na and osmolality gradually improved to normal. About the transient increase in ADH secretion, we considered that hypothalamic disturbance in NMS might induce leakage of stored ADH from neuroendocrine neurons in it.

[Clinical study on incidental renal cell carcinoma]

Between 1985 and 1992, 119 patients with renal cell carcinoma were treated at our hospital. Among these cases, 71 cases (59.7%) were incidentally detected in the absence of any suggestive clinical signs of a tumor, 41 cases (34.5%) presented urological or general signs suggestive of the tumor, and 7 cases (5.88%) were detected by metastatic lesions initially. We reviewed 71 cases of incidental carcinoma compared with 41 cases of symptomatic carcinoma. The ratio of incidental carcinoma has been increasing steadily for 8 years, and it was more than 70% of all cases in the last 3 years. The carcinoma was detected at routine health examinations in 25 cases, and during examination for unrelated diseases in 46 cases. Forty-seven cases (66.2%) were detected by ultrasonography, 24 cases (33.8%) by computerized tomography and none by intravenous pyelography. Tumor extension was within the renal capsule in 94.4% of the incidental carcinoma and the mean diameter was 4.39 cm, which was significantly smaller than that of symptomatic carcinoma (p < 0.0001). Peripheral tumors and clear cell subtype tumors were more frequently detected in incidental carcinoma (p < 0.0001 and p = 0.0018). Tumor stage and grade of tumor cell were significantly lower than symptomatic carcinoma (p < 0.0001). The five-year survival rate in incidental carcinoma was 98.5%. There was a significant difference in survival between the incidental and symptomatic carcinoma (p < 0.001).

The effects of gonadotrophin-releasing hormone agonists on iliac crest cancellous bone structure in women with endometriosis

The administration of gonadotrophin-releasing hormone (GnRH) analogs to premenopausal women causes hypoestrogenism and bone loss, but the effects on cancellous microstructure have not been determined. In this study we have assessed bone structure in transiliac biopsies obtained from women before and after treatment for endometriosis with GnRH analogs. Twenty-one premenopausal women were studied, paired biopsies being obtained in 13; five women received both GnRH analogs and Org OD 14 (Tibolone, Livial). Comparison of pre- and post-treatment biopsies in women treated only with GnRH analogs showed a reduction in indices related to connectivity (node-to-terminus ratio, node-to-loop strut length, p < 0.02) and increase in inversely related indices (terminus-to-terminus and node-to-terminus strut length, p < 0.03). No significant changes were seen in any of the structural indices in women receiving both GnRH and Org OD 14 therapy. Activation frequency and bone formation rate at tissue level increased in women treated with GnRH agonists alone, although this change was not statistically significant. Our results suggest that bone loss induced by GnRH analogs may be associated with adverse effects on cancellous microstructure which are unlikely to be reversed following cessation of therapy. Concurrent treatment with Org OD 14 appears to prevent these changes.

Two enhancer elements for DNA replication of pSC101, par and a palindromic binding sequence of the Rep protein

The minimal replication origin (ori) of the plasmid pSC101 has been previously defined as an approximately 220-bp region by using plasmids defective in the par region, which is a cis-acting determinant of plasmid stability. This ori region contains the DnaA binding sequence, three repeated sequences (iterons), and an inverted repeat (IR) element (IR-1), one of the binding sites of an initiator protein, Rep (or RepA). In the present study, we show that plasmids containing par can replicate at a nearly normal copy number in the absence of IR-1 but still require a region (the downstream region) between the third iteron and IR-1. Because par is dispensable in plasmids retaining IR-1, par and IR-1 can compensate each other for efficient replication. The region from the DnaA box to the downstream region can support DNA replication at a reduced frequency, and it is designated "core-ori." Addition of either IR-1 or par to core-ori increases the copy number of the plasmid up to a nearly normal level. However, the IR-1 element must be located downstream of the third iteron (or upstream of the rep gene) to enhance replication of the plasmid, while the par region, to which DNA gyrase can bind, functions optimally regardless of its location. Furthermore, the enhancer activity of IR-1 is dependent on the helical phase of the DNA double helix, suggesting that the Rep protein bound to IR-1 stimulates the activation of ori via its interaction with another factor or factors capable of binding to individual loci within ori.